Earlybird@BarlowPark Enrolment Application Form
Please complete this enrolment form for each child you are considering enrolling at the Earlybird@BarlowPark Educare centre.
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What is your child's full first name? (as reflected on their birth certificate) *
What is your child's surname? (as reflected on their birth certificate) *
Is there a 'preferred' name your child usually goes by? (This will be used by their teacher for labeling etc.)
What is your child's date of birth? *
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What is your child's identity number as reflected on their birth certificate?
What is your child's gender identity?
Clear selection
What is the primary language your child hears spoken most at home?
Clear selection
Is there a secondary language your child hears spoken a great deal at home?
Clear selection
What is the FIRST NAME of the primary adult caregiver (parent/guardian) for this child? i.e. first point-of-contact for teachers and principal in matters related to the child? *
What is the SURNAME of the primary adult caregiver (parent/guardian) for this child? *
What is this primary caregiver's relationship to the child?
Clear selection
What is the child's primary caregiver's ID number?
What is the child's primary caregiver's email address? *
What is the child's primary caregiver's cellphone number? *
What is the child's primary caregiver's work contact number?
What is the full name and surname of the secondary adult caregiver for this child (i.e. second point-of-contact for teachers and principal in matters related to the child)?
What is this secondary caregiver's relationship to the child?
Clear selection
What is the child's secondary caregiver's ID number?
What is the child's secondary caregiver's email address?
What is the child's secondary caregiver's cellphone number?
What is the child's secondary caregiver's work contact number?
Please indicate whether the primary or secondary caregiver will be assuming responsibility for payment of the child's school fees: *
What date do you anticipate this child being ready to begin school at the Earlybird@BarlowPark Educare Centre? (Please note that this is the date we will begin invoicing you from if you complete our enrolment process). *
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What is the physical address of the child's home?
What is the contact telephone number for the child's home?
Which family members does the child live with at this home on most week days?
If the child is currently enrolled at another preschool or educare centre or creche, please give us its name:
Please list any allergies your child has:
Please list any medical conditions your child has:
Please give us the name of your child's GP or Paediatrician:
Please give us a contact number for your child's GP or Paediatrician:
If your child is covered by medical aid, please give us the medical aid's name:
Medical aid membership number:
Please acknowledge that in order to complete Earlybird's enrolment process and secure your child's spot at the Earlybird@BarlowPark Educare Centre you will need to go through the following steps with the centre's principal: *
Required
Thank you very much for taking the time to fill out the enrolment form. Please use the notes section below to let us know if you have any questions for us or if you want us to be aware of any additional information relating to your child (particularly if your little one has experienced any significant learning and development challenges to date):
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This form was created inside of Earlybird Educare.