Chitter-Chatter-Educare | Online Application

Please complete this form in full, fields marked with a * are required.

Proposed Start Date Term : *

Of Year : *

Grade Applying For *

STUDENT DETAILS

Student's First Name *

Student's Last Name *

Student's Preferred Name (optional)

Student's Mobile Number

Student's Email Address(optional)

Student's Gender *

Male Female

Student's Date Of Birth *

Student's ID or Passport Number *

Nationality *

Right or Left Handed

Race *

Place of Birth*

Weekly Boarding Required

Religion

Home Language *

Allergies *

Allergy Action Required

Allergy Status *

Compulsory Immunisations Up to date *

Medical Conditions

Medical Aid Scheme

Medical Aid Number

Primary Members Details

Medicine Not To Be Administrated At School

Dietary Requirements *

Home Medication

SIBLINGS

Select Number Of Siblings *

PREVIOUS SCHOOL DETAILS

School Name if applicable

From Grade

To Grade

Last Grade Passed

Reason For Leaving

PARENT / GUARDIAN 1 DETAILS

Relationship To Student *

Title *

First Name *

Last Name *

Email *

Home Phone Number

Mobile Phone Number *

Work Number

Address *

Nationality *

ID Number/Passport Number *

Marital Status *

Does The Student Reside With You? *

Occupation

Position

Employer's Name

Employer's Number

Did You Attend This School

If Yes What Year Did You Leave

PARENT / GUARDIAN 2 DETAILS

Relationship To Student

Title *

First Name *

Last Name *

Email *

Home Phone Number

Mobile Phone Number *

Work Number

Address*

Nationality *

ID Number/Passport Number *

Marital Status

Does The Student Reside With You? *

Occupation

Position

Employer's Name

Employer's Number

Did Parent 2 Attend This School

If Yes What Year Did They Leave.

OTHER CONTACTS

Doctor's Name *

Doctor's Phone Number *

Approved Pick Up Name

Approved Pick Up Phone Number

Their ID Number

Second Approved Pick Up Name

Second Approved Pick Up Phone Number

Their ID Number

Emergency Contact *

Emergency Contact Phone Number *

Person Responsible For Account *

Enter Their Mobile Number *

Person Responsible Email Address*

DAYCARE OPTIONS

Early Care

Half Day

Full Day

Include Lunch

MEDIA CHANNEL PERMISSIONS

Do you consent to your child appearing in all School related media? *

Upload a recent headshot of your child

Supported files : .jpg, .jpeg, .png

LETTER MOTIVATING WHY THIS IS YOUR SCHOOL OF CHOICE

Maximum of 500 Characters

SUPPORTING DOCUMENTS

Student's Unabridged Birth Certificate *

Supported files : .jpg, .jpeg, .png

Parent 1 ID / Passport

Supported files : .jpg, .jpeg, .png

Parent 2 ID / Passport

Supported files : .jpg, .jpeg, .png

School Report (optional)

Supported files : .jpg, .jpeg, .png, pdf, doc, docx

DECLARATION

I / We hereby declare that both Parents/Guardians whose details appear on the above application form consent to the submission of said application to Chitter Chatter Educare.