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SURNAME OF LEARNER

NAMES OF LEARNER:

DATE OF BIRTH OF LEARNER:

AGE ON ADMISSION:

GENERAL HEALTH CONDITION:

GENDER OF LEARNER:

HOME LANGUAGE OF LEARNER:

LEARNER STREET ADDRESS

TOWN:

POSTAL CODE:

NAME OF PREVIOUS SCHOOL:

SURNAME OF GUARDIAN

NAMES OF GUARDIAN

MARITAL STATUS:

GUARDIAN STREET ADDRESS

TOWN:

POSTAL CODE:

CELL PHONE NO.

OCCUPATION

EMPLOYER'S NAME:

WHO IS LIABLE FOR SCHOOL FEES?

WHO DOES THE CHILD STAY WITH?

DOES THE CHILD RECEIVE SOCIAL GRANT?

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