Admission

Siblings

Number of other Children at this school:

Position in the family (e.g., first):

Please supply full names below:

Parent / Guardian Information

Complete a SEPARATE parent form for each parent living at a different physical address

Title:

Initials:

Surname:

First Name:

Gender:

Male Female

Home Language:

Race:

ID / Passport Number:

Account Payer:

Yes No

Residential Address:

City / Surbub:

Postal Code:

Occupation:

Employer:

Surname of Spouse:

First Name:

Occupation Of Spouse:

Learner resides with his/her parent/s:

Yes No

Spouse ID Number:

Relationship To Learner:

Parent Marital Status:

Correspondence Details

Title:

Surname:

Postal Address:

City / Suburb:

Postal Code:

Other Contact Details

Home Number:

Work Telephone:

Fax Number:

Cell Number:

Spouse Work Telephone Number:

Spouse Cell Number:

E-Mail Address:

Spouse E-Mail Address:

Declaration

I hereby declare that to the best of my knowledge, the above information as supplied is accurate and correct.

Name of Parent / Guardian:

Date:

APPLICATION FOR ADMISSION TO SCHOOL

THE SEEKERS TOWER MATHS AND SCIENCE ACADEMY

Previous School Information

Learner Medical Information

Siblings

Parent / Guardian Information

Correspondence Details

Other Contact Details

Declaration