Student Registration Form

Luleka Cares (Pty) Ltd

1 NYONI 3 STREET
Pietermaritzburg
KwaZulu Natal
South Africa
320

www.lulekacares.co.za

call us now! 0823821923
Student Registration Form
- Full Name
  
  First NameMiddle NameLast Name
- Birth Date
  
  MonthDayYear
- Gender
- ID Number
- Contact Number
- Permanent Address
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip CodeCountry
- Next Of Kin
  
  First NameLast Name
- Relationship
  ex. Father, Mother, etc.
- Address Of Next of Kin
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Phone Number Of Person To Contact In Case Of Emergency
  Please enter a valid phone number.Format: (000) 000-0000.
- Email Of Person To Contact In Case Of Emergency
  example@example.com
- High School Name
- List of Achievements
  
  File should be in pdf, doc/docx format.
  Cancelof
- Other Extra Curricular Activities
- Program Selection
- Payment Details
  
  Fees must be paid to this Account with your ID Number as reference
- Attachment checkup List
- Please verify that you are human
- - AFTER FILLING AND SIGNINING THIS FORM ,IT MEANS STUDENT
  AGREES TO TERMS AND CONDITIONS OF LULEKA CARES
  - THIS FORM IS FILLED AND SUBMITTED ALONG WITH R500 REG FEE
  - STUDENT PAYS R600 TH AFTER REGISTRATION MAKING R1200 TOTAL.
  - LULEKA CARES PRIORITIZES RESPECT ,IF THE STUDENT FAILS TO
  COMPLY THE ,THE AGREEMENT WILL BE TERMINATED EMMEDIETELY
  AND THERE WILL BE NO REFUND
  -LULEKA CARES IS UNDER NONQOMA COLLEGE ACCREDITED BY QCTO
- Should be Empty:

Student Registration Form

Payment Details