Application Part 1 – Ambleside Ballito

Welcome

We are delighted that you are considering partnering with us in educating your child. Please complete the form in full. If you have any questions or difficulties along the way, don't hesitate to contact us on admin@amblesideballito.co.za This is form 1 of 3 and needs to be completed in one sitting.

Email *

CHILD'S INFORMATION

Starting Date *

Name *

First

Last

Calling name (if different from the first name)

Date of Birth *

Gender *

Place in family (e.g. 1st of 2 children, only child etc) *

Country of birth *

Nationality *

ID Number / Passport Number *

Home language *

Other languages spoken or understood *

Home address *

Does the child live in a single home with both parents/guardians? If not, please describe home circumstances and living arrangements for the child *

Is there a Court Order or Parenting Plan relevant to the child?

CURRENT SCHOOL DETAILS

Present Grade *

Name of current / previous school *

School Email address *

Has your child ever been suspended or expelled from a school? *

Names, ages and schools of siblings *

PERSONALITY

Describe your child in a few sentences: their personality, strengths and struggles *

What tends to capture his / her interest? What does he / she enjoy doing?

FAMILY INFORMATION

FATHER / GUARDIAN

Parental Role *

Title *

Name *

First

Last

Home address *

Email *

Cellphone Number *

ID Number / Passport Number *

Nationality *

Marital Status *

Occupation *

Self-Employed / Employer Name *

Work Number *

Do you belong to a faith community? If so, which one? *

MOTHER / GUARDIAN

Parental Role *

Title *

Name *

First

Last

Email *

Cellphone Number *

Home Address *

ID Number / Passport Number *

Nationality *

Marital Status *

Occupation *

Self-Employed / Employer Name *

Work Number *

Do you belong to a faith community? If so, which one? *

FEE INFORMATION

Who is responsible for fee payment? *

Father / Guardian
Mother / Guardian
Other

DETAILS OF PERSON RESPONSIBLE FOR PAYMENT IF 'OTHER'

Title

Name

First

Last

ID Number / Passport Number

Home Address

Cellphone Number

DETAILS OF FEE PAYMENT

Please note that school fees are calculated as an annual amount and are payable over 12 months from January to December regardless of school holidays, unless the annual payment method is selected. Please note that if another person is responsible for fee payment or part thereof, they too will be required to sign the parent-school enrolment contract should your child be accepted.

To the best of your knowledge, and taking all present circumstances into account, are you able to afford the school fees? *

If 'no', please indicate how you intend obtaining financial assistance (e.g. from family, church, or other agency).

Do you give consent for a consumer credit check? *

PLEASE INDICATE YOUR PREFERRED FEE OPTION

Primary School Programme

Monthly Debit Order
Annually (10% discount)

MEDICAL INFORMATION

Doctor's Details

Doctor's Name *

Doctor's Number *

Paediatrician's Name

Paediatrician's Number

Medical Aid Details, if relevant

Name of Medical Aid

Medical Aid Number

Principal Member's Name

Principal Member's ID Number

Additional Emergency Contacts

Please provide additional contact information for designated persons that we can contact in an emergency in the event that you, the parents or guardians, are not reachable.

Name *

First

Last

Relation to child *

Cellphone Number *

Allergies or other medical conditions or concerns we should know about

If medication is required to be administered at school you will be required to upload a consent form in section 3.

Allergies *

Other

Has your child had any traumatic experiences (physical or emotional) which we should be made aware of (i.e. abuse, assault, family deaths, surgeries, serious illness, sibling illness, etc.)? *

ADDITIONAL SUPPORT AND DEVELOPMENT NEEDS

Is your child currently receiving, or has he/she previously received support/therapy for any of the following? *

Please provide details of nature and duration of any form of therapy.

ADDITIONAL INFORMATION

Please tell us how you heard about this school *

CONSENT & INDEMNITY

Three Peaks School ("The School") hereby reserves the right of admission and the right to request a parent to remove a child from The School should we consider this to be in the interest of the child (the “Pupil”). I/we the undersigned, 1. accept that The School, in partnership with Ambleside Schools International, is established on a Christian foundation and particular pedagogical convictions. By enrolling our child in The School we accept that he/she will participate in a programme shaped by these beliefs and values (as outlined in the booklet “Our Guiding Principles and our Partnership with Ambleside Schools International”), and will be cared for by teachers who embrace Christianity as their way of life. 2. hereby consent to the person in charge acting “in loco parentis” whilst the Pupil attends The School or participates in any extra-mural activities, including but not limited to games, sporting activities, educational tours and excursions. 3. fully understand and accept that all excursions shall be taken at the Pupil’s own risk and we hereby, on behalf of ourselves, and the Pupil indemnify, hold harmless and absolve The School, its principal, teachers, staff, employees, volunteers, servants or agents against and from any or all claims whatsoever that may arise in connection with any loss or damage to the property or injury to the person of the Pupil aforesaid in the course of such tour or excursion, or arising there from or in consequence therewith. 4. hereby indemnify, hold harmless and absolve The School, its Principal, teachers, staff, employees, servants or agents against all or any loss, damage (direct or indirect, consequential or otherwise) or injury, expenses (including medical expenses), costs (including legal costs on the scale as between attorney and own client) suffered and /or incurred by the Pupil in or on the premises of The School (Holy Trinity Church, 5 Vriende Street, Gardens, Cape Town) or in the course of any extra-mural activities, including games, sporting activities, educational excursions or in consequence of any other act or omission of whatsoever nature and howsoever arising by The School, its Principal, teachers, staff, employees, volunteers, servants or agents. 5. hereby agree to pay the monthly school fees on or before the 1st day of each month, unless alternative arrangements have been made. We further agree that refunds will not be made for cancellation or absence due to holiday, or illness. 6. hereby agree a term’s calendar notice, in writing, is required before removing our child from The School. We further agree that if the required notice is not given, the fees for the term will still be required to be paid in full. I/We, the undersigned, acknowledge that we have read and understand the said Consent and Indemnity Form and that by agreeing, consider myself/ourselves bound by such rules and conditions, thereby granting consent and indemnity as stipulated above.

I hereby acknowledge that the information I have provided on this Application Form is accurate and complete. I understand that by providing inaccurate information, I may disqualify my child for acceptance. I understand that if a place is offered to my child, I will enter into a contract with The School. *

True
False

I acknowledge that by checking this box and submitting this electronic form, I am signing the form electronically. *

True
False