JBAY TECHNICALCOLLEGE:

Application Form2015

LEARNER NAME:__________________________

GRADE: _________________________________

APPLICATION FOR 2015

NON REFUNDABLE REGISTRATION FEE OF R450 PAYABLE ON SUBMISSION OF APPLICATION Banking details: Jbay Acdemy, Standard Bank Branch code:050315, account number: 252461398Reference – Students name. NAME OF STUDENT

N COURSE APPLYING FOR:

CURRENT SCHOOL:

LEARNERS MEDICAL INFORMATION

MEDICAL AID:

MEDICAL AID NO:

MAIN MEMBER:

NAME OF GP:

GP TEL:

ALLERGIES:

IMMUNISATION:

SPECIAL MEDICAL PROBLEMS REQUIRING COUNSELLING:

STUDENT DETAIL

FULL NAME AND SURNAME:

DATE OF BIRTH:

HOME LANGUAGE:

HOME ADDRESS:

PLACE OF CHILD IN THE FAMILY (1ST, 2ND, 3RD CHILD):

OTHER DETAIL

PHYSICAL DISABILITIES:

LEARNING DISABILITIES:

SOCIAL DISABILITIES:

PLEASE INCLUDE THE FOLLOWING

COPY OF MOST RECENT SCHOOL REPORTCOPY OF ANY PROFESSIONAL REPORTSCOPY OF THE BIRTH CERTIFICATE

PLEASE INDICATE ANY APPROPRIATE INFORMATION IN THE FOLLOWING AREAS

OTHER DETAIL

MOTHER NAME:

WORK ADDRESS:

WORK TEL:

CELL:

EMAIL:

FATHER NAME:

WORK ADDRESS:

WORK TEL:

CELL:

EMAIL:

EMERGENCY CONTACT (OTHER THAN PARENTS):

STUDENT CELL NUMBER:

STUDENT EMAIL ADDRESS:

SCHOOL FEES

1. Who will be responsible for the school fees:

2. Payment method

3. School fees are payable in advance by the 1st of each month.

4. The parents must be aware that the school fees are payable in respect of any and each individual academic school year (12 months).

5. SCHOOL FEES: R1250

6. Parents are jointly and severely liable in the personal capacities for the payments of the school fees.

7. In event of the parents being in default of payment of the school fees-interest at the rate of 20% per annum will be levied on all such amounts which are due as calculated from the date upon which it became payable.

8. Legal steps will be instituted against them without prior notification for the recovery of such arrear fees in which event the parents will be liable for all legal costs and expenses as between attorney and own client including such collection commission which may lawfully become due . Cancellation – 2 months notice .

CASH DEBIT EFT

RESPONSIBILITIES OF THE LEARNER

•LEARNER MUST BEHAVE IN ORDERLY MANNER•MUST ACCEPT DISCIPLINE WHICH IS NECESSARY FOR THE GOOD FUNCTIONING OF THE ACADEMY•ATTEND ACADEMY FAITHFULLY(if not parents are to inform us by either telephone or email)

NAME OF PARENT NAME OF PARENT

_____________________ ______________________

SIGNATURE OF PARENT SIGNATURE OF PARENT

_____________________ _______________________

DATE ______________ SIGNATURE OF JBAY ACADEMY ______________________