Natasha & Lucy Pre Primary

STARTING BLOCKS

MONTESSORI 18 MONTHS – 5 YEARS NATASHA & LUCY PRE PRIMARY 2006/057447/23 MARSH MEMORIAL HOMES PO BOX 9 NORTON WAY RONDEBOSCH RONDEBOSCH 7700 7700 TEL: 021 6896135 FAX:021 6896135 EMAIL: [email protected] ENROLEMENT FORMS YEAR APPLIED FOR: TODDLER Class BRIDGING Class 4-5½ YEAR OLDS class (18 months – 2 ½ yrs) (3 yrs – 4 yrs)

FULL NAME OF CHILD:

DATE OF BIRTH SIBLINGS AGES:

RESIDENTIAL ADDRESS:

HOME LANGUAGE: RELIGION:

MOTHER: FATHER: NAME: NAME:

WORK: WORK: HOME: HOME:

MOBILE: MOBILE: EMAIL: EMAIL:

OCCUPATION: OCCUPATION:

BUSINESS ADDRESS: BUSINESS ADDRESS:

DOCTORS NAME AND TEL: In the event of an emergency, please provide at two names and telephone numbers of people we can contact.

1) ………………………………………………………… relationship

2) ……………………………………………………….. relationship

3) ………………………………………………………… relationship

Who will bring your child to school?

………………………………………………………………………………….. Who will collect your child from school?

…………………………………………………………………………………. Has your child attended any other form of pre-school?

………………………………………………………………………………………………….. Please provide any other information below with regards to your child, which could affect his/her behaviour, eg Allergies, medication, family relationships, divorce, separation

………………………………………………………………………………………………………… ……………

My child will/will not be requiring aftercare until 2pm/4pm/5.00pm. I am aware that I am responsible for paying monthly aftercare fees once my child has signed up for it and need to give 3 months (1 terms) notice should I no longer require aftercare. I am also aware that I still need to pay my monthly aftercare fees during the school holidays.

SIGNED……………………………………………………………………

DATE:………………………………. CONSENT AND INDEMNITY

Please note that this form is to be completed by legal guardian/s of the child.

,……………………………………………………………………………………………………………. (full names)

Of …………………………………………………………………………………………………………………. (residential address)

The guardian of ……………………………………………………………………………………………... (child’s full name)

Do hereby give consent for my child to take part in the activities of Starting Blocks Montessori School, including classroom and playground activities as well as such educational excursions that may be arranged by the school. I request that the staff members/appointment to be in charge of my child “act in loco parentis” during the course of the activities.

I fully understand and accept that all the activities shall be participated in at my child’s own risk. On behalf of myself, my executors, my wife/husband and my child, I hereby indemnify, hold harmless and absolve the Principal, staff and members of the Board of Trustees of the school and any parent who has been appointed by the school to transport my child against any and all claims whatsoever that may arise in the connection with the loss of or damage to the property of injury to the person of my child in the course of the activities, in the knowledge that all responsible precautions will nevertheless be taken for the safety and welfare of my child. I understand that if transporting school children on outings that each child will be adequately secured by seat belts and accompanied by a parent and/or staff member.

I also understand and accept that one terms written notice must be given of intention to remove my child from the school or the use of the aftercare facilities during the school term. Failing this, I agree to pay a terms school fees( 3 months) in lieu of notice.

SIGNATURE OF GUARDIAN/ SIGNATURE AND DATE OF PARENT WITNESS

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