Enrolment Form and Terms and Conditions
Section 1- Child details
Examples are shown in italics in the right hand column
John Smith
20 September 2007
Male / Female
1.
2.
3.
4.
5.
6.
Child's Name:
Date of Birth:
Child's Gender:
Enrolment Date:
School Class:
Allergies
7.
Previous pre-school
attended
Doctor
Doctor telephone number
8.
9.
1.
2.
Penicillin
Nuts, eggs etc
Twinkle Pre-school, Baby
Graduates
Dr de Greef
011-672-1234
*PLEASE ATTACH A COPY OF YOUR CHILD'S CLINIC CARD
Section 2 – Parent (No 1) Details
1.
2.
3.
4.
Title:
Full Name:
Surname
ID Number
5. Relationship to child
6. Residential Address
Copy of ID MUST be attached
7. Postal Address
8.
9.
10
11
12
Home Telephone No.
Work Telephone No.
Mobile Number
Fax Number
Email Address
Mrs
Susan Nomeko
Hlatshwayo
7211251077087
Mother
Ceder Complex
22 Seringboom Avenue
Randburg
2194
PO Box 1023
Randburg
2194
011-672-1234
011-794-1234
082 000 000
011-794-0000
[email protected]
.za
Section 3 – Parent (No 2) Details
1. Title:
2. Full Name:
3. Surname
©2011 Playschool Academy
Mrs
Susan Nomeko
Hlatshwayo
4. ID Number
Copy of ID MUST be attached
5. Relationship to child
6. Residential Address
7. Postal Address
8.
9.
10.
11.
12.
Home Telephone No.
Work Telephone No.
Mobile Number
Fax Number
Email Address
7211251077087
Mother
Ceder Complex
22 Seringboom Avenue
Randburg
2194
PO Box 1023
Randburg
2194
011-672-1234
011-794-1234
082 000 000
011-794-0000
[email protected]
.za
Section 4 – Family member not living with you – Details
1.
2.
3.
4.
Title:
Full Name:
Surname
ID Number (Copy of ID
MUST be attached)
5. Relationship to child
6. Residential Address
Mrs
Susan Nomeko
Hlatshwayo
7211251077087
Mother
Ceder Complex
22 Seringboom Avenue
Randburg
2194
7. Postal Address
PO Box 1023
Randburg
2194
8. Home Telephone No.
011-672-1234
9. Work Telephone No.
011-794-1234
10. Mobile Number
082 000 000
11. Fax Number
011-794-0000
12. Email Address
[email protected]
NO PERSON MAY COLLECT YOUR CHILD IF YOU HAVE NOT MADE ARRANGEMENTS WITH THE OFFICE
Section 5: Information required in case of an emergency or hospital
treatment
1.
2.
3.
4.
5.
6.
Medical Aid Name
Name of main member
Medical Aid Number
Beneficiary Name
Benefit Date
Date of Birth
©2011 Playschool Academy
Discovery
Mr. T.J. Hlatshwayo
123456789
Child’s name
2001/10/25
2002/01/02
I________________________________________________________________ parent/guardian of
_________________________________(Full name and surname) cede my power as parent/guardian to the
principal of Playschool Academy or her representative should medical treatment be required for my child. As far as
I know he/she is in a good state of health. I accept that all reasonable precautions will be taken for the safety and
well being of my child and that I will be held responsible for paying any medical and/or hospital accounts where
applicable. I do however request that the responsible person to take note of the following: (Any particulars in
connection with your child's state of health: allergies, operations, epileptic, diabetic etc.
Section 7: Terms and Conditions
1.
I/we choose the address supplied in the enrolment form as my/our domicilium citandi et executandiand I/we
will receive all notices and/or other correspondence at this address.
2.
I/we undertake to notify Playschool Academy of my change in my/our domicilum citandi et executandi in
writing within 10 days of said change. If I/we do not, Playschool Academy may assume that my/our
domicilium citandi et executandi has stayed unchanged.
3.
Any notice in terms of this contract which is -sent by prepaid registered post in a correctly addressed envelope
to the address specified in the enrolment form, shall be deemed to have been received by me/us; delivered to
me/us by hand at the address specified in the enrolment form shall be deemed to have been received on the
day of delivery, provided that it has been delivered to a responsible person during ordinary business hours;
sent by fax/e-mail to me/us at the number specified in the enrolment form shall be deemed to have been
received within 4 (four) hours of it being sent during office hours and within 12 (twelve) hours of it being sent
outside of office hours.
4.
For purpose of all proceedings under this contract, the parties hereby consent to the jurisdiction of
Johannesburg Magistrate Court.
5.
Clause 4 shall be deemed to constitute he required written consent-conferring jurisdiction upon the court in
terms of section 45 of the Magistrate's Courts Act 34 of 1994.
6.
Clause 4 and 5 shall continue to be binding on the parties notwithstanding an termination or cancellation of
this contract or any part thereof.
7.
I/we undertake to pay the school/transport fees in the amount of R_____________ before or on the 5th day
of each month, failing which Playschool Academy may take such action as they deem necessary to collect the
fees.
8.
I/we further agree that I/we will be responsible for the costs, calculated on the attorney's own client scale,
incurred in collecting said school fees as well as any other collection costs failing my/our payment.
9.
Playschool Academy may vary the school / transport fees at their discretion provided that it is done in writing
and with at least 1 (one) months prior notice.
©2011 Playschool Academy
10. All clients utilizing the transport service, note that the children MUST be at the pick up point on time. We can
unfortunately NOT wait for any children as it makes the bus late for the next collection and it has a major
impact on the rest of the schedule.
11. Be informed of the 10% late payment charge. Ensure that your account is paid before or on the first day of
the month. Late payment charges will be added if payment is received after the fifth day of the month. We
have to meet our financial obligations and NO exceptions will be made.
12. Times: 06h00 to 18h00 Adhere strictly to these times. A late collection fee will be charged should children be
collected after 18h00. (R100 per half hour or part thereof) The register must be signed by the person who
collects the child. Staff members are being paid overtime.
Section 8: Indemnity Form
I hereby declare that I have read the contract explaining the terms and conditions and payment system. I fully
understand and accept this information as binding upon me/us. I also declare that I fully understand that Ivon
Muller will not be held liable for any loss, damage, injury of whatever nature consequential or otherwise however
caused at the school or on transport. I also understand that my vehicle and its contents are parked at my own risk
and that I enter and exit the premises and bus at my own risk. I undertake to pay the prescribed fees not later
than the fifth day of each month and I take note of the 10% penalty for late payments. I also understand that a full
month’s written notice (PAID) is required on termination of registration school/transport contract. I undertake to
complete the termination of registration form provided by Playschool Academy. I take note that fees are payable
twelve (12) months of the year, irrespective of holidays. Aftercare children have to pay an additional holiday care
fee for mornings attending the school. Transport children have to pay an additional fee should the bus have to
deviate from the set route or have to make additional trips. I, the undersigned do hereby undertake to abide by all
the rules that are stipulated and that I will be held responsible for all legal expenses that may be incurred due to
the breaching of this contract. This contract is binding and I agree to abide by the rules as stipulated.
Signed on this ________day of ______________________________________20_______
_________________
____________________________
Signature of Father
Full name of Father in block letters
_________________
____________________________
Signature of Mother
Full name of Father in block letters
©2011 Playschool Academy