Online Application Form

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Name

APPLICATION FOR ADMISSION

Grade 11 and 12 applications will only be considered if your child has been attending an IEB school.

INFORMATION REQUESTED BY THE DEPARTMENT OF EDUCATION

Level of Education

Pre-Primary Primary High School

Application for Grade

In Year

DETAILS OF APPLICANT

First Name of Applicant

Gender

Male

Female

Surname of Applicant

Race

Previous Surname

Preferred Name

Email Address

Emergency Number

Home Telephone Number

Cellphone Number

Left or Right Handed

Left-handed Right-handed

Citizenship

Identity Number

Physical Address

Postal Code

Province

Country

Home Language

Preferred Language of Instruction

Mode of Transport

Contact Number

Social Grant

Yes

APPLICANT'S CURRENT / PREVIOUS SCHOOL

Current school or school last attended by applicant

Full address of school

Telephone Number of School

Fax Number

Date of leaving

Present Grade

Reason for leaving

Has the applicant repeated a Grade?

Yes

If YES, which grade?

Has the applicant previously applied at Willow Academy?

Yes

If YES, which year?

Has the applicant applied to any other schools?

Yes

If YES, which schools?

Does the applicant actively participate in the school's sports and culture program?

Yes

If NO, specify reason:

Please list any of the applicant's achievements at their current or previous schools:

Cultural:

Academic:

Sport:

Leadership:

DETAILS OF APPLICANT'S PARENTS

Details of Applicant's Parents

Deceased Parents

Mother

Father

Both

None

FATHER OR LEGAL GUARDIAN

Father/ Legal Guardian Surname

Title

First Names

Identity Number

Residential Address

Postal Code

Postal Address

Postal Code

Occupation

Employer

Work Address

Marital Status

Single

Married

Separated

Divorced

Widowed

Remarried

Living together

Yes

Please upload a copy of the death / marriage certificate, if applicable

Home Telephone Nr

Cell Number

Work Tel.

Email Address

MOTHER OR LEGAL GUARDIAN

Mother / Legal Guardian Surname

Title

First Names

Identity Number

Residential Address

Postal Code

Postal Address

Postal Code

Occupation

Employer

Work Address

Marital Status

Single

Married

Separated

Divorced

Widowed

Remarried

Living together

Yes

Please upload a copy of the death / marriage certificate, if applicable

Home Telephone Nr

Cell Number

Work Tel.

Email Address

CHRISTIAN BACKGROUND

At Willow Academy, Christian education is compulsory for all pupils. Willow Academy is a Christian school and Christian education forms part of the examinable curriculum of every child. Therefore, it is understood that you do not have any conscientious objection to him/her being present for lessons, devotions and assemblies.

Congregation

Minister / Pastor

Contact Number for Minister / Pastor

Is the father of the applicant a born again Christian?

Yes No

Is the mother of the applicant a born again Christian?

Yes No

Is the applicant a born again Christian?

Yes No

If not Christian, what religion does the applicant follow?

MEDICAL INFORMATION

Medical Aid Number

Membership Number

Principal Member

Principal Member's ID No.

Name of Doctor

Telephone Number of Doctor

Name of Dentist

Telephone Number of Dentist

Special Educational Needs, Health Problems or any other important information (e.g. Asthma, Epilepsy, Allergies etc.) including medical requirements:

PERMISSION TO USE IMAGES

From time to time we may take pictures of our learners during events such as camps, sporting events, school activities or outreaches. These images may be included in our promotional material, social media, newspapers etc.

Agree or Not

Yes No

INFORMATION REQUESTED BY THE ACCOUNTS DEPARTMENT

Account Information

By entering an email address below, you give permission for accounts and other correspondence to be delivered to you via email.

Name and Surname of person to whom account must be sent:

Email address to which account must be sent:

As the parent / guardian of the applicant I undertake on behalf of myself, my executors, my spouse and my son/daughter/ward aforesaid to:

1. Hold myself responsible for the payment of the full amount of fees as determined by the Governing Body of Willow Academy and disbursements to be charged by Willow Academy in respect of the whole period during which my son/daughter/ward is registered as a pupil at Willow Academy or have his/her enrolment at Willow Academy terminated;

2. Pay all fees charged by Willow Academy in advance by debit order;

3. Accept liability for all penalty fees, collection commission and tracing charges should fees and/disbursements become overdue;

4. Give at least three full months' notice in writing to the Principal or to pay three full months' fees in lieu of notice upon terminating enrolment of my son/daughter/ward from Willow Academy;

5. Accept any jurisdiction of the Supreme Court and/or Magistrates Court of South Africa;

6. Accept liability for all attorney and client charges, collection commission and tracing charges, should legal action be instituted against me.

IMPORTANT: Non-payment of fees for three months will result in automatic termination of enrolment at Willow Academy.

I have read the above declaration and agree to these terms. *

Agree

FURTHER CONDITIONS OF ENROLMENT

Contract Conditions

As the parent / guardian of the applicant I certify that the above information is correct and request that my son/daughter/ward be admitted as a pupil to Willow Academy and I undertake to:

1. Permit my son/daughter/ward to participate in the educational programme

2. Seek alternative schooling should my son/daughter/ward not manage academically and/or if the age of my son/daughter/ward should fall out of the normal range for a particular grade.

3. Support the policy that pupils are expected to participate in sport and/or cultural activities unless the Principal grants permission to the contrary and I give consent for my son/daughter/ward to take part in any extra-mural activities of Willow Academy

4. Conform to the rules and regulations laid down by the Willow Academy Governing Body and/or Principal from time to time and ensure that my son/daughter/ward does the same, failing which , I understand that the Governing Body may expel my son/daughter/ward from Willow Academy following a disciplinary hearing;

5. Indemnify, hold harmless and absolve Willow Academy and its staff or their authorised legal agents against any claims that may arise from any injury, death, loss, damage, costs or expense, including legal costs, suffered by me or my son/daughter/ward at any time whilst enrolled as a learner at Willow Academy

6. Give permission for my son/daughter/ward to participate in Christian instruction and prayers

I have read the above conditions and agree to these terms. *

Agree

ADMISSIONS CHECKLIST

Your Application will not be processed unless the following documents are uploaded on the following page.

Admissions Checklists

Willow Academy application form

Copy of latest academic report

Four colour ID photographs

Certified copy of birth certificate or identity document

Copies of both parents' identity documents

Proof of residence (RICA document e.g. celllphone bill)

Copy of pay slip of person responsible for fees

Pastoral Recommendation (document enclosed with application)

Admission to school document from previous school (document enclosed with application)

Student Visa (for foreign learners only)

Proof of Payment of Application Fee (payable with application)

SUBMIT DOCUMENTS

Copy of latest academic report

Colour ID photograph

Copy of birth certificate or identity document

Copy of Father/ Guardian's birth certificate

Copy of Mother/ Guardian's birth certificate

Proof of residence (Rica document e.g. cellphone bill)

Copy of Payslip of person responsible for fees

Pastoral Recommendation

Admission to school document from previous school

Student Visa (for foreign learners only)

Proof of Payment of Application Fee

Thank you for submitting your documents to Willow Academy. We will communicate with you via email concerning your application.

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