The surname and name reflected on the Birth Certificate / Identity Document are the ONLY surname and name we are allowed to use for the learner.

Name of Learner

Grade Applying for
Grade RGrade 1

Surname of Learner

Full First Name(s) of Learner

Gender
MaleFemale

Home Language

Population Group (Department requirement)
AfricanColouredIndianWhiteOther

Religion

Dexterity
Left HandedRight HandedAmbidextrous

Learner's Current Residential Address

Province

Country of Birth

Date of Immigration

Citizenship

Learner resides with

If NOT a South African, please provide below:

Athlone Primary School Sports House of Biological siblings / parent only
LEO (Yellow)ORION (Green)TAURUS (Red)

Registered for Grant: (Social / Child Support / Foster)
YesNo

If yes, please indicate which Grant and amount received

Mode of Transport
CarOn Foot (Please note a letter is required by the school if the child walks to and from school)Other

SECTION C: MEDICAL DETAILS OF LEARNER

Please supply details of any medical conditions your child has:

EMERGENCY CONTACT (OTHER THAN PARENTS)

MEDICAL HISTORY OF LEARNER
Allergies

Existing Medical Problems

Please indicate any appropriate information below:
Learning disabilities

Social disabilities

Has your child been assessed by an Educational Psychologist / Speech Therapist / Occupational Therapist? If yes, please attach copies of the Assessments.
YesNo

Is the child currently on routine medication?
YesNo

If yes, please specify:

MEDICAL AID DETAILS

Member’s Name

Membership Number

Medical Aid Name

Specific Plan

Doctor’s Name

Telephone Number

SECTION D: DETAILS OF PARENTS / GUARDIANS

BIOLOGICAL MOTHER
Surname

First Name

Identity Number

Marital Status
MarriedSingleDivorced (Please supply copy of Divorce Order)Re-married
Home Phone Number

Cell Phone Number

Business Number

Email

Physical Address

Postal Address (If different to above)

Name and address of Employer

Occupation

BIOLOGICAL FATHER
Surname

First Name

Identity Number

Marital Status
MarriedSingleDivorced (Please supply copy of Divorce Order)Re-married
Home Phone Number

Cell Phone Number

Business Number

Email

Physical Address

Postal Address (If different to above)

Name and address of Employer

Occupation

LEGAL GUARDIAN (1)
Surname

First Name

Identity Number

Marital Status
MarriedSingleDivorced (Please supply copy of Divorce Order)Re-married
Home Phone Number

Cell Phone Number

Business Number

Email

Physical Address

Postal Address (If different to above)

Name and address of Employer

Occupation

LEGAL GUARDIAN (2)
Surname

First Name

Identity Number

Marital Status
MarriedSingleDivorced (Please supply copy of Divorce Order)Re-married
Home Phone Number

Cell Phone Number

Business Number

Email

Physical Address

Postal Address (If different to above)

Name and address of Employer

Occupation

SECTION E: DECLARATION BY BIOLOGICAL PARENT (1)&(2) / GUARDIAN (1)&(2)

I / We (Full Name of Parent / Guardian)

and

the parents / guardians of (Full Name of Learner)

hereby declare that:
All the particulars contained in this application form and supporting documentation are accurate. Should any information be found to be incorrect, I accept that the application is not valid and that the school’s rights are reserved in terms of the action to be taken. I give the Chairperson of the School Governing Body, the Principal or his / her designate permission to check and confirm any of the details listed by me. Should any of the information supplied be found to be false, the School reserves the right to institute legal action against parents who may well submit fraudulent information on, or with, this application and my application will be disqualified.
1. I undertake:
a. To ensure that my child / ward attends school regularly and should my child / ward be absent from school for any reason, I will notify the school, preferably in writing, stating the reason(s) for absence;
b. To contribute to the School Fees in terms of sections 39 and 40 of the South African Schools Act, Act No 84 of 1996;
c. To pay all costs incurred for damage done or losses caused by my child / ward to school property and departmental books and equipment.
2. I agree that the principal or his / her designates may act in loco parentis in the event of any injury or accident in which my child / ward may be involved.
3. I realise that the completion of this application form does not in any way bind the school to accepting the above named child.
4. If accepted I agree that my child / ward shall abide by the RULES OF THE SCHOOL and the SCHOOL CODE OF CONDUCT.

Dated at Pietermaritzburg this

day of

20

PARENT 1 / GUARDIAN 1 (SIGNATURE)

PARENT 1 / GUARDIAN 1 (PRINT NAME)

PARENT 2 / GUARDIAN 2 (SIGNATURE)

PARENT 2 / GUARDIAN 2 (PRINT NAME)

ANNEXURE A: TERMS AND CONDITIONS

1. PREAMBLE
1.1 Athlone Primary School has not been declared as a ‘non fee paying’ school.
1.2 School fees are determined in consultation with the parents of the school.
1.3 I / We agree that it is incumbent on me / us to pay full school fees should my / our child / children be accepted to Athlone Primary School over and above a school in closer proximity to my / our place of residence.
1.4 This enrolment agreement, incorporating an application for enrolment, will govern the relationship between the parents and the Governing Body of the School if the application for enrolment is successful and for as long as the learner is attending School. The Principal shall therefore be entitled to exercise his / her professional judgement on Admissions to Athlone Primary School.
2. POPIA
Unless you instruct Athlone Primary School expressly and in writing to the contrary, your consent is given for the school to:
2.1 Collect, store and process information about you and any Third Party, divorced or separated parent responsible for payment of any or all amounts owing in school fees
2.2 Collect, store and process names, contact details and information relating to yourself and your child, and to such information being made available to other parents / guardians, staff or responsible persons engaged or authorised by the school for school-related purposes to the extent required for the purpose of managing relationships between the school, parents / guardians, and current learners as well as providing references and communicating with the body of former learners;
2.3 Include photographs, with or without name, of your child in school publications, or in press releases to celebrate the school’s or your child’s activities, achievements or successes;
2.4 Supply information and a reference in respect of your child to any educational institution which you propose your child may attend.
2.5 The school will take care to ensure that all information that is supplied relating to your child is accurate and any opinion given on his / her ability, aptitude and character is fair. However, the school cannot be liable for any loss you or your child is alleged to have suffered resulting from opinions reasonably given, or correct statements of fact contained, in any reference or report given by us.

3. PAYMENT OPTIONS
3.1 I / We undertake to pay Annual School Fees punctually in accordance with the option selected by me / us namely (indicate your choice with X). Notwithstanding clause
3.1.1 below, parents will be requested to so sign an Agreement to Pay School Fees that entitles them to pay school fees in monthly instalments from January to October of that year or in full by the end of February of that year.

Full Annual School Fees, being paid by the last day of February each year.Ten (10) monthly instalments for the period 31 January to 31 October each year.

4. LEGAL PROVISIONS
Should I / we fail to make payment in accordance with the options selected above the School may:
4.1 Institute legal proceedings against me / us for collection of the arrear School fees in which event, I / we agree to pay legal costs on the scale as between Attorney and client including collection commission and tracing fees.
4.2 I / We acknowledge that parents / guardians are jointly and severally liable for payment of School fees.
4.3 I / We choose my / our home address details in this application as my / our
domicilium citandi et executandi.
5. CREDIT SEARCHES
I / We grant permission to the finance committee to conduct credit searches to determine my / our credit worthiness.
6. SOUTH AFRICAN SCHOOLS ACT (No. 84 of 1996)
The school draws your attention to the following:
6.1 Athlone Primary School has not been declared as a ‘no fees school’.
6.2 Parents can refer to the Regulations for the Exemption of Parents from the Payment of School Fees 2005, Published under GN R1052 in GG 29311 of 18 October 2006 as amended by GN 1149 in GG 29392 of 17 November 2006 for information.
6.3 I / we agree that we shall be liable for the payment of School fees unless totally exempted from paying same.
6.4 I / we acknowledge having been informed of my / our right to apply for exemption of paying school fees.
6.5 I / we acknowledge that I / we have been informed that I / we are able to obtain a copy of the required exemption forms from the Finance Office. Should no application for exemption form or reduction in school fees on the prescribed form be received before 28 February of every year, or within 60 days of change of circumstances, then, I / we will be ipso facto barred from applying for an exemption from or reduction in school fees, and the school fees determined at the annual meeting contemplated in terms of Section 38 and 39 of the South African Schools Act 84 of 1996, as amended, will be due and payable, regardless of whether I / we would otherwise have qualified for an exemption from or reduction in school fees.
6.6 False information or fraudulent documents will declare this application form null and void.
7. I / WE UNDERTAKE TO:
7.1 Inform the school in writing of any change of address and contact numbers.
7.2 Inform the school in writing of any case of infectious illness in my / our household.
7.3 To comply with all health regulations, including those relating to medical inspections and immunisation against normal infectious and / or contagious diseases.
7.4 Ensure that my / our child attends school regularly.
7.5 Ensure that my / our child complies with the rules and regulations of the school. The parent acknowledges that the learner will at all times be subject to the rules of the school and the provisions of the relevant Acts of Parliament in force from time to time.
7.6 Give 1 (one) term’s written notice of any intention to withdraw my / our child from the school. The Governing Body may require the parent to pay the school’s fees and any charges due for the term following the final term of attendance.
7.7 I / we understand and accept that, in addition to the school’s fees, further charges may be incurred and that such charges may include the cost of excursions, sports equipment, books etc.
7.8 Athlone Primary School, the Governing Body and staff shall not be responsible at any time for the loss, theft or damage of any items belonging to the parent or the child. It is the duty of the parent to adequately insure against such loss.
7.9 I / we will incur costs for damages done or losses caused by my / our child to the School or State property / equipment.
7.10 I / we understand that my / our child shall be expected to participate in organised school activities.
7.11 I give my / our consent for my child to participate in school excursions of an educational, cultural or sporting nature.
7.12 I / we agree that the Principal or his / her designates may act as loco parentis in the event of any injury or accident in which my / our child may be involved should his / her parents / guardians be unavailable.
7.13 The Principal or his / her designate reserves the right to search pupil’s bags should it be deemed necessary in the event of school security or learner safety being compromised.
7.14 I / we accept that I / we do not have any objections to my / our child’s achievements and / or photographs being posted in print, electronic or social media by Athlone Primary School.

Please note that you will be contacted in writing, by the Athlone Primary School, regarding acceptance. An acceptance deposit of R3 200.00 must be paid to the school for confirmation of registration. This amount will be offset against your first month’s school fees payment.
Should your circumstances change and you withdraw your application once the admissions process has been completed, the acceptance deposit of R3 200.00 will be non- refundable and will be used to cover the administration cost of the admission process.

Dated at Pietermaritzburg this

day of

20

PARENT 1 / GUARDIAN 1 (SIGNATURE)

PARENT 1 / GUARDIAN 1 (PRINT NAME)

PARENT 2 / GUARDIAN 2 (SIGNATURE)

PARENT 2 / GUARDIAN 2 (PRINT NAME)

WITNESS 1 (SIGNATURE)

WITNESS 1 (PRINT NAME)

WITNESS 2 (SIGNATURE)

WITNESS 2 (PRINT NAME)

ANNEXURE B: STATUTORY OBLIGATION TO PAY SCHOOL FEES

1. I / We hereby apply to have the child whose name appears on this application form as a learner at Athlone Primary School.
2. I / We hereby certify that I / we are the biological / adoptive parents and that I / we have legal custody and / or legal guardianship in respect of the above named learner.
3. We take note and understand the following:
a. Compulsory annual school fees for as adopted by the majority of parents at the Annual General Meeting (AGM) are attached.
b. School fees are payable in advance and are due on the first day of school.
c. The payment options are as follows:
Fees can be paid in full by the end of February.Fees can be paid off in 10 monthly equal instalments.
d. If school fees are paid in full on or before the last day of February, then a discount will be deducted from your annual school fees.
e. If parents are in arrears with one instalment, then the full amount becomes due and payable immediately.
f. A sum of R1 000.00 is to be paid upon acceptance of your child. This amount will be deducted from the first month’s school fee payment. You will be notified in writing of the outcome of your application.
g. Biological / adoptive parents are jointly and severally liable for the payment of the school fees irrespective of their marital status.
h. In the event of non-payment of school fees, the school will institute legal action against both parents irrespective of maintenance and court orders which may exist between the parties.
i. In terms of Section 39 of the South African Schools Act, parents are liable to pay compulsory school fees. This is a statutory obligation.
j. In terms of Section 40 and 41 of the South African Schools Act, the school may enforce the payment of these compulsory fees.
k. In the event of the school having to take legal action for the recovery of school fees, all legal costs, including attorney / client fees and collection costs incurred by the school will be charged to the parent’s account.
l. I / We have been informed that if we are unable to pay school fees I / we may apply for an exemption of these fees.
m. If parent(s) fail to meet their school

4. I / We undertake to give one term’s notice in writing of any intention to remove my / our child from the school and furthermore to return any books and / or equipment belonging to the school which our child may have.

5. Unless you instruct the Athlone Primary School expressly and in writing to the contrary, your consent is given for the school to:
a. Collect, store and process information about you and any Third Party, divorced or separated parent responsible for payment of any or all amounts owing in school fees
b. Collect, store and process names, contact details and information relating to yourself and your child, and to such information being made available to other parents / guardians, staff
ANNEXURE B: STATUTORY OBLIGATION TO PAY SCHOOL FEES
12
or responsible persons engaged or authorised by the School for School-related purposes to the extent required for the purpose of managing relationships between the School, parents / guardians, and current learners as well as providing references and communicating with the body of former learners;
c. Include photographs, with or without name, of your child in school publications, or in press releases to celebrate the school’s or your child’s activities, achievements or successes;
d. Supply information and a reference in respect of your child to any educational institution which you propose your child may attend. We will take care to ensure that all information that is supplied relating to your child is accurate and any opinion given on his / her ability, aptitude and character is fair. However, the school cannot be liable for any loss you or your child is alleged to have suffered resulting from opinions reasonably given, or correct statements of fact contained, in any reference or report given by us.

6. The signatory hereto hereby chooses domicillium citandi et executandi as indicated below. In the event of a change of address, parents are to notify the school in writing.
ADDRESS:
The signatory hereto hereby chooses domicillium citandi et executandi (official address) as:

7. The above is valid from the day on which it is signed by the parent / guardian to the day on which the learner officially leaves the school.

DECLARATION: PARENT / GUARDIAN 1
I
hereby declare that the information which I have recorded in this form is true and correct and by my signature below, I give the Chairman of the School Governing Body or his designate, permission to check and confirm any of the details or documents given by me. I understand that should any of the information supplied by me be found to be false, action may be taken against me.
Dated at Pietermaritzburg this

day of

20

PARENT / GUARDIAN 1 (SIGNATURE)

DECLARATION: PARENT / GUARDIAN 2
I
hereby declare that the information which I have recorded in this form is true and correct and by my signature below, I give the Chairman of the School Governing Body or his designate, permission to check and confirm any of the details or documents given by me. I understand that should any of the information supplied by me be found to be false, action may be taken against me.
Dated at Pietermaritzburg this

day of

20

PARENT / GUARDIAN 1 (SIGNATURE)

ANNEXURE C: FINANCIAL CLEARANCE CERTIFICATE

Name of Parent

Name of Pupil

ID number of Parent

Name of school where pupil is currently enrolled

Annual fees for (year)

Fees paid to date

Fees outstanding

Comments

ANNEXURE D: CONSENT TO USE PERSONAL INFORMATION

CONSENT FORM IN TERMS OF THE PROTECTION OF PERSONAL INFORMATION ACT 4 OF 2013 (POPIA)
By agreeing to the terms of this information form, you,

hereby voluntarily authorise Athlone Primary School to process your personal information as well as that
of the learner

including the names, physical address, telephone numbers and any other information you have provided to the school.

Processing shall include the receipt, recording, organising, collation, storage, updating or modification, retrieval, alteration, consultation and use; the dissemination by means of transmission, distribution or making available in any other form, or the merging, linking as well as blocking, degradation, erasure or destruction of information. This consent is effective immediately and will remain effective until one of the conditions stated under paragraph 8 of the Policy on the Protection of Personal Information has been met. The personal information may only be processed if it is adequate, relevant and not excessive, given the purpose for which it is processed, and if processing occurs in accordance with the relevant provisions of POPIA. The purpose of the processing of information must relate to a function or an activity of the school.
In addition, you hereby take note that Athlone Primary School collects and processes personal information pertaining to the proper functioning, management and governance of the school, as prescribed in the South African Schools Act 84 of 1996 and other relevant education legislation and policies. The type of information will depend on the purpose for which it is collected, and will be processed for that purpose only.
In terms of Section 11 of POPIA, personal information may only be processed in the following circumstances:
 If the data subject, or a competent person where the data subject is a child, consents to the processing
 If processing is necessary to carry out actions for the conclusion or performance of a contract to which the data subject is party
 If processing complies with an obligation imposed by law on the school
 If processing protects a legitimate interest of the data subject
 If processing is necessary for the performance of a public law duty
 If processing is necessary for pursuing the legitimate interests of the school

YOUR RIGHTS IN TERMS OF THIS CONSENT
You have the following rights:
 The right to know what information is being kept, how it is being used, and when the school will disclose it (National Policy, 28 Administration (1) and (11). All of the aforesaid information is contained in our Policy on the Protection of Personal Information and our Privacy Policy, which are available and may be obtained from our offices or the D6.
 The right to correct your details. The school will try to keep your information up to date. However, should any of your details change, please notify us to ensure that our records are as accurate as possible.
 The right to revoke consent. You may revoke the consent you have given us in terms of this form at any time. Your revocation should be in writing and addressed to the Principal of the school. Revoked consent is not retroactive and will not affect any past or existing use of your information.

CONSENT TO RECEIVE MARKETING INFORMATION
By agreeing to the terms of this consent form, you expressly consent to the processing of your information for marketing purposes, and understand that by consenting, you may receive marketing materials in the form of SMSs, e-mails and the like from the school.

Grade Applying for
I AgreeI Do Not Agree

Dated at Pietermaritzburg this

day of

20

PARENT 1 / GUARDIAN 1 (SIGNATURE)

PARENT 1 / GUARDIAN 1 (PRINT NAME)

PARENT 2 / GUARDIAN 2 (SIGNATURE)

PARENT 2 / GUARDIAN 2 (PRINT NAME)