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ISA APPLICATION FORM - RECEPTION
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INTRODUCTION
Our Vision:
Mission
Core Values
SECTION A: PERSONAL INFORMATION
Child's Surname ( As it appears on Birth Certificate or Passport):
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Child's First Name and Other Names ( As they appear on Birth Certificate or Passport):
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Date of Birth:
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Gender:
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Nationality:
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Name of Siblings in ISA (if applicable)
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Languages Spoken
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Residential Address
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Parent / Guardian Information 1 (Newmont Employee)
Relationship to Child
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Name:
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Title:
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Occupation:
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Newmont Employee ID and Department
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Mobile Phone Number/s
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Newmont Extension
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Work Email
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Personal Email
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Parent / Guardian Information 2
Relationship to Child:
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Name:
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Title:
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Occupation
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Employer
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Mobile Phone Number/s
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Work Email
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Personal Email
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Emergency Contact Details
Emergency Contact Person 1:
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Phone No.
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Emergency Contact Person 2
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Phone No.
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Child's Previous Schooling Information (if applicable)
Name of School
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Dates Attended
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The Child
Has your child ever been away from you before (had a babysitter, attended Day Care by him/herself?)
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If yes, give details.
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Is your child toilet-trained?
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Is there anything that frightens your child?
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If yes, please explain.
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What activities does your child enjoy taking part in (e.g. sports, drama, reading, music etc)?
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SECTION B: IMMUNIZATION RECORDS
Diptheria / Pertussis / Tetanus:
Polio
Measles
Varicella:
Hepatitis B
SECTION C: HOME-SCHOOL AGREEMENT
As Parent / Guardian, I/we will:
SECTION D: DECLARATION
Signed: Parent
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Parent Name
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Date
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Please print the completed form before submission. The hard copy should be delivered at the School's office on the day of the entrance examination Thank you.
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