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Enrolment Form

Enrolment Form

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new Sinai Logo.jpgThe Sinai Academy

@ Chabad of the West Coast

15 Curlewis Road Blouberg, 7441

Phone: 021-557-7560 Fax: 021-557-9522

Email- director@sinaiacademy.co.za

Web: www.sinaiacademy.co.za

Enrolment Application Form

Preferred Enrolment Date: _________________________

PARTICULARS OF PUPIL

Child’s Surname:

Child’s First Name:

Preferred First Name:

Child’s Hebrew Name:

Date of Birth:

Time of Birth (Needed for Hebrew Birthday) :

Gender:

Home Language:

Home Address:

Postal code:

Home Phone: ( )

Father’s Name: ID:

Father’s Occupation: Work No.: ( )

Cell No.: Email address:

Mother’s Name: ID:

Mother’s Occupation: Work No.: ( )

Cell No.: Email address:

Emergency Details:

Contact Name: ______________________________ Relationship: ____________________

Phone: ( )

Cell :

Marital Status

Married Separated Divorced

If separated/divorced, for how long?

Please list any conversions in the family:

(Please include copy of conversation certificate)

Has your child attended Nursery pre-school or classes before (if yes, where)?


No Yes – Pre-school(s):

Indicate child’s particular strengths and/or deficiencies (physical, emotional, ineffectual)

Does your child have siblings?

Brother (s) Sister (s)

1. Name:

Birthday:

School:

2. Name:

Birthday:

School:

3. Name:

Birthday:

School:

YES

NO

  • I agree to my child being involved in a general assessment by a registered therapist.

  • I agree to have my child photographed for personal profiles and/or school PR.


CHILD HEALTH INFORMATION

***IMPORTANT***

Health Information

X if not applicable

Allergies (food, medication, environmental) and precautions, reactions and treatment:

Medications, food supplements, modified diet currently being administered:

Chronic Physical Problems:

History of diseases the child has had:

Any additional health or enrollment information you feel we should know about your child:

Immunization Record

YES

NO

Has your child had all the required immunizations to date?

** Please supply us with a copy of your child’s Immunisation Card.


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