Fundamental Factory Baby-, Nursery- and Pre-school
8 Ring Road, Three Rivers Proper, Vereeniging | Tel: 016 150 0016 | Fax: 016 423 2203 | E-mail: admin@fundamentalfactory.co.za
Enrolment Form
Full Names of Pupil:
*
First Name
Last Name
Date of Birth:
*
/
Day
/
Month
Year
Date Picker Icon
Enrolment Date:
/
Day
/
Month
Year
Date Picker Icon
Gender:
*
Boy
Girl
Language:
*
Other children attending our facility:
Nationality:
*
Religion:
*
Attendance:
*
Half day
Full day
Approx. Time of Arrival
*
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
10
20
30
40
50
Minutes
AM
PM
AM/PM Option
Approx. Time of Departure
*
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
10
20
30
40
50
Minutes
AM
PM
AM/PM Option
Name of Doctor:
*
Tel. No of Doctor:
*
-
Allergies or other relevant information that we need to know about eg. ‘Bee Stings’ or ‘Fever convulsions’
Do both parents have collecting or visitation rights?
*
Yes
No
Person’s name and telephone number should neither parent be available in case of an emergency
*
Name
Number
Parent's Details
Mother
Name:
Surname:
I.D. Number:
Marital Status:
Name of Employer:
Home Tel. Number:
-
Work Tel. Number:
-
Cell Number:
-
Fax Number:
-
Email Address:
Parent's Details
Father
Name:
Surname:
I.D. Number:
Marital Status:
Name of Employer:
Home Tel. Number:
-
Work Tel. Number:
-
Cell Number:
-
Fax Number:
-
Email Address:
Please respond to all questions:
Yes/No
Parents married
*
Yes
No
Parents divorced
*
Yes
No
Date of divorce
-
Day
-
Month
Year
Date Picker Icon
Widow/Widower
*
Yes
No
Unmarried parent
*
Yes
No
Child lives with grandparents
*
Yes
No
Child lives with guardian
*
Yes
No
Number of people in household:
Specify
Person responsible for payment of fees
Please Note: Fundamental Factory must at ALL TIMES be advised of any information changes.
Please Note: Fundamental Factory must at ALL TIMES be advised of any information changes.
Father's Signature
*
Clear
Mother's Signature
*
Clear
Guardian (if any)
Clear
Witness
Clear
Submit
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