119 1
st
Road, Linbro Park, Sandton, Gauteng, SOUTH AFRICA
P.O. Box 119, Linbro Park, 2065, Gauteng, SOUTH AFRICA
Telephone: (+27) 11-608-1584 / 2206
Fax: (+27) 86-671-7281
e-mail:
modmont@global.co.za
web site:
http://www.montessorint.com
APPLICATION FORM
Please note this form must be signed and completed in full by
both
parents/legal guardian, prior to admission. All application documentation appears in the checklist below. Documents 1 – 5 must be submitted by all applicants and documents 6 and 7 must be submitted by primary school applicants only. Please fill in the checklist accordingly.
APPLICATION FORM
Rows
() or n/a
1. Application Form signed by both parents/legal guardian
2. ID document/passport of both parents/legal guardian, in addition the ID of the person responsible for payment (if other than parent/legal guardian)
3. Birth certificate or ID / Passport document or passport of pupil
4. Copy of inoculation records
5. Proof of payment of admission fees
6. Primary School Pupils: Copy of pupil's most recent report, transfer card from previous school and any other relevant documentation pertaining to pupil's development
7. Primary School Pupils Code of Conduct Agreement.
For Office Use Only
Please note that completion of this form and an interview does not imply automatic acceptance.
Please indicate how you heard about the school:
1. Pupil's Details
Applicable Class:
Nursery (3 mnths – 2 yrs)
Toddler (2 – 3 yrs)
Early Childhood (3 – 6 yrs)
Junior Primary (6 – 9 yrs)
Senior Primary (9 – 13 yrs)
Attendance Option:
Half Day
Full Day
Start Date (dd/mm/yy):
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Surname:
First Name
Last Name
First Names:
First Name
Last Name
ID/Passport No:
Date of Birth:
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Age:
Gender:
Male
Female
Home Language:
SA Resident:
Yes
No
Study Permit:
Yes
No
N/A
Nationality:
Race:
Religion:
Previous care facility/school attended by pupil:
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THE COLLEGE & SCHOOL OF MODERN MONTESSORI
Reg. No. CK94/21728/2
MEMBERS: A.A. DARBY, P.A. DARBY, O.C. DARBY, A.M. DARBY
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2027 APPLICATION FORM
2. Medical and Emergency Information
Emergency Contact Person:
Telephone Number:
Format: (000) 000-0000.
Cell Phone Number:
Format: (000) 000-0000.
Family Doctor:
Telephone Number:
Format: (000) 000-0000.
Medical Aid Company:
Membership No:
Has the pupil received all the necessary inoculations? If no, give details.
Yes
No
Does the pupil have any allergies? If yes (✔), give details.
Yes
No
Does/has the pupil suffer/suffered from any illness or disability? If yes (✔), give details.
Yes
No
Is the pupil receiving any medical treatment or chronic medication for any condition? If yes (✔), give details.
Yes
No
Has the pupil suffered, or been treated for, any psychological or emotional upset? If yes (✔), give details.
Yes
No
Has the pupil had any operations? If yes (✔), give details.
Yes
No
Please specify any other relevant information pertaining to the pupil's health and well-being.
2.1 Consent
I. ________________________________, being the parent/legal guardian of ________________________________ hereby cede my power as parent/guardian to act as in loco parentis to the principal of the school or his/her representatives, should medical treatment/surgery to my child be deemed necessary. As far as I know, my child is physically capable of participating in the various activities and he/she is in good health and all relevant medical information is detailed in the form above.
Signature of Mother/Guardian
Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Signature of Father/Guardian
Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
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2027 APPLICATION FORM
3. Indemnity Form
I, ________________________________________________ acknowledge that whilst my son/daughter is attending The School of Modern Montessori; the school cannot accept any liability for mishap, loss or injury which may be suffered during attendance at the school or during participation in any pre-arranged school excursions, or extra-curricular activities. I accept that all reasonable precautions will be taken to ensure the safety and welfare of our/my child and that I shall be held responsible for the payment of medical and/or hospital accounts where applicable, should any injury or loss be sustained by my child. I specifically indemnify and hold the School and its staff blameless against any claims of any nature arising out of any injury, damage or loss sustained in pursuance of the aforesaid participation. I hereby indemnify The School of Modern Montessori in respect of all occurrences relating to the above.
Signature of Mother/Guardian
Print Name:
First Name
Last Name
Date (dd/mm/yy):
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Signature of Father/Guardian
Print Name:
First Name
Last Name
Date (dd/mm/yy):
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
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2027 APPLICATION FORM
4. General Details
Untitled Matrix
Rows
Rows
Mother/Legal Guardian
Mother/Legal Guardian
Mother/Legal Guardian
Mother/Legal Guardian
Father/Legal Guardian
Father/Legal Guardian
Father/Legal Guardian
Father/Legal Guardian
Full Name:
Relationship to Pupil:
Marital Status: ()
If Divorced or Single Parent:
If Divorced or Single Parent:
If Divorced or Single Parent:
ID/Passport Number:
Work Telephone:
Home Telephone:
Cell Phone:
Email Address:
Residential Address:
Postal Address:
Occupation:
Name of Employer:
Employer's Address:
Employer's Telephone:
Email Address (w):
If there is any background information or family history of which we should be aware, please specify below.
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2027 APPLICATION FORM
5. Fees
5.1 Details of Person Responsible for Payment
Person responsible for payment of school fees:
Father
Mother
Other
Surname:
First Name
Last Name
Relationship to Pupil:
Cell Phone Number:
Format: (000) 000-0000.
Employers Telephone:
Format: (000) 000-0000.
5.2 Admission Fees
5.2 Admission Fees
Half Day
Full Day
Half Day
Full Day
Registration Fee (non-refundable):
R 2,000.00
R 2,000.00
R 2,000.00
R 2,000.00
Deposit (refundable):
R 10,000.00
R 10,000.00
R 10,000.00
R 10,000.00
Admission Fees Payable:
R 12,000.00
R 12,000.00
R 12,000.00
R 12,000.00
Payment Method:
Amount Paid:
Payment Date:
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
5.3 School Fees
Select Applicable Attendance Option:
½ Day 3 Months - 2 Years
½ Day 3 Months – 2 Years + Lunch
Full Day 3 Months - 2 Years
½ Day Preschool
½ Day Preschool + Lunch
Full Day Preschool
½ Day Primary
½ Day Primary + Lunch
Full Day Primary
Select 1 of the following payment options:
Option 1: Annual Payment
Option 2: Termly Payments
Option 3: Monthly Payments
Select 1 of the following payment methods:
Cheque
Credit Card
Direct Deposit
EFT
Post-dated Cheques
Future Dated EFT
If other, please supply the following details and attach a copy of ID document:
ID Number:
Home Tel:
Format: (000) 000-0000.
Work Tel:
Format: (000) 000-0000.
Email Address:
example@example.com
Residential Address:
Postal Address:
Occupation:
Name of Employer:
Employers Address:
Email (w):
example@example.com
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2027 APPLICATION FORM
6. Terms and Conditions
In terms of family law, parents are jointly and severally liable for the payment of school fees irrespective of their marital status, and irrespective of maintenance and court order which may exist between the parties. By signing this Application, I/we acknowledge liability for payment of all fees and that if this application has been signed by more than one parent, the liability of signatories will be joint and several. I/we choose domicilium citandi et executandi for any correspondence or the service of any court processes at the residential address recorded on the application form and acknowledge liability for all attorney and own client costs, plus collection commission in the event of any outstanding accounts being handed over to the school's attorneys for collection.
I/We, the undersigned:
Hereby certify that the information provided by us on this application form is true, complete and accurate.
Have read The School of Modern Montessori Prospectus and accept enrolment of our child at the school according to the philosophies, policies and conditions laid down therein.
Understand that the School reserves the right in its sole discretion to amend and/or alter any of the provisions of The School of Modern Montessori Prospectus.
Are aware that annual fees are payable in advance, on or before the first day of the first term.
Are aware that termly fees are payable in advance, on or before the first day of each term.
Are aware that monthly fees are payable in advance, on or before the first day of each month and are payable over eleven months (1st January - 1st November).
Accept that a late payment penalty fee of 10% is charged on monthly overdue accounts.
Hold ourselves accountable for the prompt payment of school fees and for any late payment penalties added onto overdue accounts.
Understand that the School reserves the right to refuse admission to a child with outstanding fees.
Understand that school fees are due irrespective of absenteeism due to illness, vacation or for any other reason whatsoever.
Understand that in the event that I/we wish to remove my/our child from the school, one full term's written notice must be submitted to the office and to my/our child's class teacher(s), on or prior to the final day of the penultimate term of attendance.
We understand that failure to do so will result in the forfeiture of the deposit, in addition to being liable for one full term's fees and in lieu of notice.
Undertake to ensure that the pupil is punctual at the beginning of each school day and is collected on time at the end of each school day. Furthermore I/we accept that the late collection of my/our child is subject to a late collection charge of R100 per 15 minutes or part thereof, which is payable immediately to the teacher on duty.
Undertake to reimburse the school for any damage to school property that may be caused by the pupil.
Understand that while every reasonable effort will be made to prevent losses or damage to the pupil's clothing and equipment, the school cannot be held liable.
Understand and have discussed the school's rules and code of conduct with my/our child.
Signature of Mother/Guardian
Signature of Father/Guardian
Print Name:
Print Name:
Date (dd/mm/yy):
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Date (dd/mm/yy):
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
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2027 APPLICATION FORM
7. Primary School and High School Code Of Conduct Agreement
This agreement must be signed by all primary school pupils and their parents and returned to the school, together with the application form.
Name of Pupil
First Name
Last Name
agree to abide by the following rules:
1. I will not be late for school.
2. I will be prepared for school.
3. I will do my work to the best of my ability.
4. I will treat others with respect and dignity.
5. I will look after my belongings.
6. I will respect the property of others.
7. I will not play in areas that are out of bounds.
8. I will ensure the toilet is clean and tidy after I have used it.
9. I will make sure that I keep my classroom neat and clean.
10. I will make sure that I throw away my rubbish in the dustbin.
11. I will ensure that I do not misuse any of the equipment.
12. I will not use insulting or offensive language.
13. I will not bully, intimidate or behave in a violent manner.
14. I will not take property that does not belong to me.
15. I will follow school rules to the best of my ability.
16. I will respect my teacher and the teachers on duty aftercare duty.
17. I will treat the school property with respect and replace anything I break.
18. I will report anything that makes me unhappy to my teacher.
19. I will complete my homework every day.
20. I will not disturb another person working in my classroom.
21. I will give my parents notices to sign and bring them back to school.
22. I have read the code of conduct and understand it
Signature of Pupil
Signature of Parent
Print Name:
Print Name:
Date (dd/mm/yy):
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Date (dd/mm/yy):
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
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2027 APPLICATION FORM
8. Credit Check Permission
I,
ID / Passport
of (physical address - please provide proof)
consent and allow The School of Modern Montessori to access my full consumer profile on the database held by any credit bureau.
Signature:
Signed at:
Date:
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Confidentiality Note:
This page and any accompanying documents contain confidential information intended for a specific individual and purpose. This telecopied information is private and protected by law. If you are not the intended recipient, you are hereby notified that any disclosure, copying or distribution, or the taking of any action based on the contents of this information is strictly prohibited.
SCHOOL OF MODERN MONTESSORI, LINBRO PARK: 2027 APPLICATION FORM
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