Application Form : Customer Information
Please fill out the customer information form below. Fields marked with a red star are mandatory.
Account Holder Name
*
First Name
Last Name
Email address
*
example@example.com
Account Holder Contacts
Father Holder Phone
*
Mother Holder Phone
*
Account Holder Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Are you in a complex
*
Please Select
Yes
yes with access control
yes without access control
no
Please not there is a extra charge for a complex with access control R300pm
Add hoc Client
*
Please Select
Yes
no
Please see T & C
Seat securing fee
*
Please Select
pay upfront
make a payment plan for up to 6 months
A Refundable 50% deposit is required. please see PAYMENT TERMS on page 13 of the T & C
T & C
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Application Form : Chilled Information
Please fill out the Chilled information form below. Fields marked with a red star are mandatory.
Child details 1
*
First Name
Last Name
Grade
*
Please Select
Please select
Grade 1
Grade 2
Grade 3
Grade 4
Grade 5
Grade 6
Grade 7
Grade 8
Grade 9
Grade 10
Grade 11
Grade 12
School
*
Please Select
Beaconhouse School one-way R900
Beaconhouse School Return R1500
Montessori School one-way R450
Montessori School Return R600
Gonubie Primary School one-way R450
Gonubie Primary School Return R600
Gonubie High School one-way R450
Gonubie High School Return R600
Other
School Address
*
School
Street Address for drop off
City
State
Zip Code
Home class Teacher name
*
Mr.
Mrs.
Prefix
First Name
Last Name
Trip times required
*
Pick up mornings: Time : If you require a return Pick up Afternoons Time :
Child details 2
First Name
Last Name
Grade
Please Select
Please select
Grade 1
Grade 2
Grade 3
Grade 4
Grade 5
Grade 6
Grade 7
Grade 8
Grade 9
Grade 10
Grade 11
Grade 12
Address
School
Street Address
City
State
Zip Code
Home class Teacher name
First Name
Last Name
Trip times required
Pick up mornings: Time : If you require a return Pick up Afternoons Time :
Child details 3
First Name
Last Name
Grade
Please Select
Please select
Grade 1
Grade 2
Grade 3
Grade 4
Grade 5
Grade 6
Grade 7
Grade 8
Grade 9
Grade 10
Grade 11
Grade 12
Address
School
Street Address
City
State
Zip Code
Home class Teacher name
First Name
Last Name
Trip times required
Pick up mornings: Time : If you require a return Pick up Afternoons Time :
Any allergic or medical conditions
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Date of application
This contract is valid from date below to the end of the current year
Date of application
-
Month
-
Day
Year
Date of application
Terms and Conditions
*
Signature
*
Date
*
-
Month
-
Day
Year
Date
Submit
All customer information will be kept with discretion and will not be used for other marketing or advertisement purposes without customer approval.
Should be Empty: