Thank you for your interest in Stirling Pre-School. We look forward to getting to know you and your child.

Enrolment Form

Today’s date:                          ____________________________
Where did you hear about us? : ____________________________
Child’s Full Name:                    ____________________________
Known as:                               ____________________________
Proposed Date of Enrolment:     ____________________________
Enrolling for Grade:  00/ 000/0000.  (Circle one)
Date of birth:                           ____________________________
Female/Male. (Circle one)   
Home language:                      ____________________________
Home Address:                        ____________________________
Mailing Address:                      ____________________________
Previous School:                      ____________________________
Teacher:                                 ____________________________
Telephone Number:                 ____________________________
Siblings and dates of birth:       ____________________________

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Mother’s Name:                     ____________________________
Cell:                                     ____________________________
Home:                                  ____________________________
Work:                                   ____________________________
Home Address:                      ____________________________
I.D. number:                         ____________________________
Company Name and Location: ____________________________
Email address:                      ____________________________
Is email an effective way of communicating with you? Yes / No
Married/Divorced/Widowed (Circle one) 

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Father’s Name:                      ____________________________
Cell:                                     ____________________________
Home:                                  ____________________________
Work:                                   ____________________________
Home Address:                      ____________________________
I.D. number:                         ____________________________
Company Name and Location: ____________________________
Email address:                      ____________________________
Is email an effective way of communicating with you? Yes / No
Married/Divorced/Widowed (Circle one) 

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The following to be paid on application: Non-refundable R400 registration fee:  R1900 deposit.

Amount Paid: :______________________________
Date Paid: :    ______________________________
Method: :       ______________________________
Cheques to: “Stirling Pre-School”. 
There is a 5% discount for siblings on fees excluding the deposit.
Standard Bank, Fourways Crossing:  009953.  #: 02 33 29 254. Current Account. “Stirling Pre-School.”
Person responsible for fees: :    ______________________________
Person responsibleDirect tel #:   ______________________________
Other contact numbers:  Work: :______________________________
Home:                                    ______________________________

Fees to be paid in advance on the 1st day of each month.  Payment made after the 7th will incur a late charge.

I agree to pay the school fees on time. 
Signature: _________________________
Date:       _________________________

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MEDICAL HISTORY: 
Medical Aid name: __________________________
Number:               __________________________
Main member:      __________________________
Allergies:             __________________________
Doctor’s Name:     __________________________
Tel:                     __________________________
Emergency Contacts other than the above:

Name:     __________________________
Number:  __________________________
Relation: __________________________

Name:    __________________________
Number:  __________________________
Relation: __________________________

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HOME ROUTINE:  Are there any problems of concern: _______________________________

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INDEMNITY: I, the undersigned (print):  ___________________________
being the guardian of (child):               ___________________________

do hereby indemnify and hold harmless Stirling Pre-School and its employees, or anyone entrusted to help out at the school, against all claims for damages arising out of any injury or loss sustained by reason of the use of the School’s premises or equipment or as a result of anything not maliciously done or omitted by the said School or any of its members, or entrusted parties, during such time as my said child attends the school, on or off the premises.  Furthermore, I give permission to the school to take my child on outings, knowing that they will always travel with a seatbelt. I also give permission to the school to take medical action if, in the event of an injury or illness, the school is unable to contact me.

Printed Name: _____________________________
Signature:      _____________________________
Place:            _____________________________
Date:             _____________________________