Edupac Demo School
New Enrolment


New Learner Details
(* required fields.)
 
Surname *
  Full Names *
  Preferred Name *
Gender *
xv
Birth date *
v
ID Number *
Grade *
xv
Admission Date *
v
Previous School
Highest Grade Passed
Medical Aid
x...v
Medical Aid Number
Medical Aid Member
Nationality
xv
Is Immigrant Immigration Date
v
Home Language
xv
Preferred Language
xv
Additional Language
xv
Ethnic Group *
xv
Religion
xv
Care Centre?
Disabilities
Allergies
Bus Service?

Student Documents

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Maximum file size: 1 MB.



Primary Guardian
(* required fields.)
 
Relationship *
xv
Title *
xv
Surname *
Full Names *
Initials *
Gender *
xv
ID Number *
Company?
Occupation
x...v
Marital Status
xv
Ethnic Group *
xv
 
Primary Guardian Contact Details
Contact Number (W)
Contact Number (H)
Contact Number (C) *
Contact Email *
 
Primary Guardian Residential Address   
Country
xv
Province
xv
City
xv
Suburb
xv
Street
Postal Code
Primary Guardian Postal Address
Country
xv
Province
xv
City
xv
Suburb
xv
Street
Postal Code
Secondary Guardian
(* required only if Secondary Guardian info are captured.)
 
Relationship *
xv
Title *
xv
Surname *
Full Names *
Initials *
Gender *
xv
ID Number *
Company?
Occupation
x...v
Marital Status
xv
Ethnic Group *
xv
 
Secondary Guardian Contact Details
Contact Number (W)
Contact Number (H)
Contact Number (C)
Contact E-mail
 
Secondary Guardian Residential Address
Country
xv
Province
xv
City
xv
Suburb
xv
Street
Postal Code
Secondary Guardian Postal Address
Country
xv
Province
xv
City
xv
Suburb
xv
Street
Postal Code

Primary Guardian Documents

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Allowed file extensions: .jpg, .jpeg, .gif, .png, .pdf, .doc, .docx,.xls, .xlsx
Maximum file size: 1 MB.



I certify that all information given in this application, supporting documents, and interviews is correct to the best of my knowledge. I understand that any false information, omissions or misrepresentations of facts called for in this application may disqualify my application or result in termination.

By submitting my personal information via this form, I provide consent for Edupac Demo School to use my information for the Admission Application and whilst enrolled at Edupac Demo School.




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