STUDENT APPLICANT PERSONAL INFORMATION

APPLICATION FOR ADMISSIONGrade 9Grade 10Grade 11

GenderMaleFemale

Are there any siblings (brothers or sisters) at WesterfordYesNo

PARTICULARS REGARDING PARENTS OR GUARDIAN

• If there are two sets of parents or guardians, both are entitled to vote at an election of the Board of Governors.
• The information below should therefore be given in respect of each parent or guardian.
• A copy of an UNABRIDGED BIRTH CERTIFICATE is required.

Parent/guardian with whom pupil lives:
(please indicate by selecting the checkbox next to Mother, father or guardian or both)

MOTHER OF STUDENT

MARITAL STATUSMarriedRemarriedDivorcedSingleWidowedSeparated

Parent/guardian with whom pupil lives: (Please Check if Father)

FATHER OF STUDENT

MARITAL STATUSMarriedRemarriedDivorcedSingleWidowedSeparated

Parent/guardian with whom pupil lives: (Please Check if Guardian)

GUARDIAN OF STUDENT

MARITAL STATUSMarriedRemarriedDivorcedSingleWidowedSeparated

Please indicate illness(es) pupil has had by selecting checkboxes that apply

MeaslesGerman MeaslesWhooping CoughChicken-poxMumpsNone of the Above

Other important illness(es) or disabilities from which the pupil is suffering or has suffered

Operation(s) pupil has had

Please indicate illness(es) pupil has been immunised against by selecting the checkboxes that apply

Tuberculosis (BCG)DiphtheriaWhooping CoughChicken-poxMumpsTetanusPoliomyelitisNone of the Above

PARTICULARS REGARDING PARENTS OR GUARDIAN

If there are two sets of parents or guardians, both are entitled to vote at an election of the Board of Governors. The information above should therefore be given in respect of each parent or guardian.

SIGNATURE: State whether father, mother or guardian*

• Copy of final report (Previous grade)
• Mid-year report (Current Grade)
• Copy of Unabridged Birth Certificate
• Copy of either rates account or lease agreement as confirmation of permanent residential address
• Citizenship: If non SA – a copy of your residency permit and a copy of your child’s study permit must be attached

PLEASE ATTACH ANY RELEVANT DOCUMENTS HERE: