Mbhasobheni Online Enrolment Form – wp.mbhasobheniprimary.com

LEARNER'S PARTICULARS

Student Full Name

First

Middle

Last

Initials:

Applying for Grade (R to 7)

Year when grade was passed:

Date Of Birth

YYYY/MM/DD

Gender

RACE (Select one):

Parent/Guardian Full Name

First

Last

Parent/Guardian Email

Additional Information (Parent/Guardian to Complete)

Country of residence

Citizenship:

Province:

ID/Passport No:

Parent/Guardian Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Phone

Home Tel:

Emergency Tel:

Learner Cell:

Email Address:

Email

Confirm Email

WhatsApp Number:

Home Language:

Preferred Language of Instruction:

Boarder:

Yes
No

Mode of Transport:

Deceased Parent:

Mother
Father
Both
None

Religion: Payer OTHER

Religion:

PREVIOUS SCHOOL INFORMATION

Name of Previous School:

Address Of Previous School:

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Province:

LEARNER MEDICAL INFORMATION

Medical Aid Number:

Medical Aid Name:

Doctor’s Name:

Doctor’s Address:

Address Line 1

Address Line 2

City

State

Zip Code

Doctor’s Tel:

Medical Condition:

Special Problems (Counselling):

Dexterity:

Right-handed
Left-handed

PARENT / GUARDIAN INFORMATION

Title:

Initials:

Parent / Guardian Name

First

Middle

Last

Gender

Male
Female

Parent / Guardian ID/Passport:

Account Payer

Yes
No

Residential Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Employer:

SPOUSE INFORMATION

Spouse Name

First

Middle

Last

Spouse Occupation:

Learner lives with parent

Relationship to learner:

Marital Status:

Spouse ID Number:

CORRESPONDENCE DETAILS

Title:

Surname

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

OTHER INFORMATION

Ambidextrous

Social Grant:

SIBLINGS

Number of children at this school:

Position in family:

Upload Proof Of Payment Of R250

Drag & Drop Files, Choose Files to Upload You can upload up to 2 files.

Upload June Report

Drag & Drop Files, Choose Files to Upload You can upload up to 2 files.

Upload Birth Certificate

Drag & Drop Files, Choose Files to Upload You can upload up to 2 files.

Upload ID Copy Of Parent/Guardian

Drag & Drop Files, Choose Files to Upload You can upload up to 2 files.

DECLARATION: I hereby declare that the above information is correct.

Accept