Imagine College Application Form

IMAGINE
COLLEGE
35 Wingfield Avenue Birdhaven Johannesburg
PO Box 55017 Northlands 2116
Tel (011) 788 5454 Fax (011) 880 2674
BIRDHAVEN
Application Form
Necessary supporting documents, completed sections and forms
1. Copy of learner's birth certificate/ID
2. Copy of parents'/legal guardians' IDs
3. Proof of residence/study permit, if foreign
4. Two recent ID photos of learner
5. Copy of learner's most recent two progress reports
6. Proof of payment: non-refundable application fee R900
Account Name: Bellavista School
Bank: Standard Bank
Branch Code: 004305
Account No.: 001986686
Reference: your child's full name
When all sections are completed, signed and saved please email the completed application form with
the above supporting documents to secretary@bellavista.org.za
Application Details
Year for enrolment application:
Start date envisaged:

DayMonthYear
Date
Learner details
Surname:
Name/s as on birth certificate:
Preferred name:
ID number:
Date of birth:

DayMonthYear
Date
Current age:
Gender:
Nationality / Country of Origin:
Date of immigration, if applicable:
Home language/s:
Further language/s:
Race:
Resides with parent / guardian:
Religion:
Alison Scott (Executive Principal)
W Marshall (Chairman)
A division of Bellavista NPO Reg No.1973/000002/08 PBO No.930005282
NPO No.045/268/NPO. Member of the Independent Schools Association of Southern Africa.

Learner Education Details
Current school:
Grade:
Grade/s repeated:
Has admission to any school ever been refused? Yes/No
If yes, please state the reason below:
ACADEMIC: achievements, difficulties, medical disorders, latest school report.
NON-ACADEMIC INTEREST AND ACHIEVEMENTS: Sport, music, performing arts, hobbies
Personal Details of Parent/Legal Guardians
I/we, the undersigned parent/s/guardian/s, hereby certify that the information provided in this application for admission is complete and accurate. We acknowledge that enrolment is subject to, inter alia, signing a learner admission contract that contains the detailed terms, conditions and requirements for admission. I/we consent to the processing of personal information contemplated in the POPI Act No 4 of 2013 (privacy statement available here., for the following purposes:
1. evaluation of this application form;
2. administration of the contract between myself and Bellavista School;
3. conducting credit enquiries.
Alison Scott (Executive Principal)
W Marshall (Chairman)
A division of Bellavista NPO Reg No.1973/000002/08 • PBO No.930005282
NPO No.045/268/NPO. Member of the Independent Schools Association of Southern Africa.

Credit Report
As part of the learner admission process, the school is required to obtain credit reports or other related information on the account of the account holder, as may be deemed necessary. The purpose of the credit report is to assess the account holder's financial means and ability to satisfy the financial obligations. You are required to sign consent below and return to the school's finance department with your completed application form. I/We the undersigned, hereby authorise Bellavista School and/or any of its associates to conduct credit enquiries and/or obtain credit reports in respect of my/our credit profile, as may be necessary, with the credit bureau of its choice.
Signed: Parent 1
Date:

MonthDayYear
Date
Signed: Parent 2
Date:

MonthDayYear
Date
Personal Details of Parent/Legal Guardian (1)
Surname:
Full names as on ID:
ID/ Passport number:
Designation:
Relationship:
Marital Status:
Occupation:
Country of origin:
Employer:

Rows	Residential Address:	Work Address:	Postal Address:
1

Tel. H:
Format: (000) 000-0000.
Tel. W:
Format: (000) 000-0000.
Cell:
Format: (000) 000-0000.
Email address or contact with regards to this application:
example@example.com
Parental Status:
Learner living with parent/s
Access rights to learner
Learner's legal guardian
Access rights in emergency only
Alison Scott (Executive Principal)
W Marshall (Chairman)
A division of Bellavista NPO Reg No.1973/000002/08 • PBO No.930005282
NPO No.045/268/NPO. Member of the Independent Schools Association of Southern Africa.

Rows	Residential Address:	Work Address:	Postal Address:
1

Tel. H:
Format: (000) 000-0000.
Tel. W:
Format: (000) 000-0000.
Cell:
Format: (000) 000-0000.
Email address or contact with regards to this application:
example@example.com
Parental Status:
Learner living with parent/s
Access rights to learner
Learner's legal guardian
Access rights in emergency only
Alison Scott (Executive Principal)
W Marshall (Chairman)
A division of Bellavista NPO Reg No.1973/000002/08 PBO No.930005282
NPO No.045/268/NPO. Member of the Independent Schools Association of Southern Africa.
Should be Empty:

Credit Report