Application for Admission

Future Focus Learning Centre

Reg no.: 2018/206549/07

Required Documents

The following documents must accompany this application:

Applicant's most recent school report (copy)
Applicant's medical report (copy) - any known allergies, previous illnesses, physical or learning difficulties, including any relevant information on past medical treatment/s, therapy, occupational should be disclosed
Applicant's birth certificate or identity document (copy)
Both parent's identity documents (copy)
Non-refundable Enrolment Registration Fee to be paid in full (Proof of Payment)

Learner Details

Surname *

First Name *

Nickname

ID Number *

Date of Birth *

Gender *

Current Grade *

Cell Number

Home Language *

Most Recent School Attended *

Date of Entry *

Details of Long-term Medication

Details of Any Medical Condition

Father's Details

Surname *

First Name *

ID Number *

Employer

Occupation

Phone (Home)

Phone (Work)

Phone (Cell) *

Email Address *

Home Address (in full) *

Mother's Details

Surname *

First Name *

ID Number *

Employer

Occupation

Phone (Home)

Phone (Work)

Phone (Cell) *

Email Address *

Home Address (in full) *

Other Guardian (if applicable)

Complete only if someone other than parents is the guardian

Title & Name

Surname

Phone (Home)

Phone (Work)

Phone (Cell)

Email Address

Address (in full)

Person Responsible for Account

Title & Name *

Surname *

Relationship *

Phone (Work)

Phone (Cell) *

Email Address *

Address (in full) *

Family Information

Family Doctor *

Doctor's Tel/Cell Number *

Medical Aid *

Membership Number *

Alternative Guardian (Emergency Contact)

In case of an emergency

Title & Name *

Surname *

Phone (Work)

Phone (Cell) *

Email Address *

Address (in full) *

Declaration

1. I/We declare that all the particulars furnished by me/us on this form are true and correct. I undertake to comply with the conditions, rules, regulations and decisions of the Future Focus Learning Centre and any amendments thereto, which may be applicable to learners in general and in the field which I am/we are registered.

2. I/We confirm the above address is correct and acknowledge to be my current address - "domicilium citandi et executandi".

3. I/We agree that the monthly fees are to be paid in advance, whether upon receipt of invoice or by the 1st of every month and that registration fee are non-refundable.

4. I/We will give 3 Months notice in writing (e-mail), in advance.

5. I/We understand that my child has never participated in the use or distribution of any illegal substance or undergone any serious disciplinary action.

6. I/We agree that Future Focus Learning Centre may check and confirm any information on the application form and may make any enquiries it deems necessary, including credit worthiness with any credit bureau and previous schools/centres.

Non-payment of fees will result in automatic suspension of the learner.

** ALL INFORMATION IS STRICTLY CONFIDENTIAL **