Online Application Form Page 1 Page 2 Page 3 Page 4 Page 5 Page 6 Page 7 Order Number 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-PrimaryPrimaryHigh 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-handedRight-handed Citizenship Identity Number Physical Address Postal Code Province Country Home Language Preferred Language of Instruction Mode of Transport Contact Number Social Grant Yes No 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 No If YES, which grade? Has the applicant previously applied at Willow Academy? Yes No If YES, which year? Has the applicant applied to any other schools? Yes No If YES, which schools? Does the applicant actively participate in the school's sports and culture program? Yes No 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 Mr Dr Adv Other 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 No Please upload a copy of the death / marriage certificate, if applicable Add Files Home Telephone Nr Cell Number Work Tel. Email Address MOTHER OR LEGAL GUARDIAN Mother / Legal Guardian Surname Title Miss Mrs Adv Dr Other 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 No Please upload a copy of the death / marriage certificate, if applicable Add Files 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? YesNo Is the mother of the applicant a born again Christian? YesNo Is the applicant a born again Christian? YesNo 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 YesNo 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.