Urban Academy E-Learning Admissions Form

2. Account Holder

The Account Holder referred to in this section is the person/entity who assumes the full responsibility of making payments to Urban Academy for Services or Products delivered.
Title *
Name *

First Name Middle Name Last Name
I.D. Number *
Type of I.D. *

SA I.D. Passport
Birth Date *

Month Day Year
Date of Birth
Citizenship *
Phone Number *
Email *
example@example.com
Residential Address *

Street Address

Street Address Line 2

City Province

Postal / Zip Code

3. Parent / Legal Guardian

The onus is on the legal guardian/parent to ensure that the learner(s) takes on the responsibility to complete all work as required in a timely fashion - that is assignments, tests and all assessments etc. More information available in our Terms & Conditions / Policy / Contract.
Is the Guardian/Parent the same person as the Account Holder? *

Yes (Skip This Section) No (Complete This Section)
Title
Name

First Name Middle Name Last Name
I.D. Number
Type of I.D.

SA I.D. Passport
Birth Date

Month Day Year
Date of Birth
Citizenship
Phone Number
Email
example@example.com
Residential Address

Street Address

Street Address Line 2

City Province

Postal / Zip Code

5. FINANCIAL SELECTION

PLEASE READ EACH DESCRIPTION CAREFULLY
1. ONCE-OFF PAYMENT

This is the full payment of the school year as per quote from Urban Academy Financial Department. This option comes with a 10% off the yearly total/quote. The Urban Academy Financial Department will be in contact with you if you select this option.

2. MONTHLY PAYMENT VIA EFT/CARD/TRANSFER/CASH

Clients agree upon an equal amount monthly instalment as agreed with the Urban Academy Financial Department. The Urban Academy Financial Department will be in contact with you if you select this option.

3. MONTHLY DEBIT ORDER

Urban Academy will Set Up an Automated Debit Order. The Urban Academy Financial Department will be in contact with you if you select this option.
Select the option you wish to make use of *

Once-Off Payment Monthly Payment Monthly Debit Order
Contractual Signature *
Should be Empty:

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2. Account Holder