Registration Child's InformationNameLast NameKnown AsGenderSelectMaleFemaleDate of BirthHome LanguagePrevious Institutions(Do not fill if not applicable)Name of InstitutionSuburb/TownDuration of AttendanceMedical InformationMedical Aid SchemeMembership NumberDoctor's NameDoctor's Telephone NumberAllergies or Chronic IllnessesSpecial Medication (Specify)Parent Information(Mother)Name & SurnameID NumberUpload fileDrag and Drop (or) Choose FilesStreet AddressCityState/ProvinceZIP / Postal CodeOccupationHome ContactWork ContactCellphone NumberEmail AddressParent Information(Father)Name & SurnameID NumberUpload fileDrag and Drop (or) Choose FilesStreet AddressCityState/ProvinceZIP / Postal CodeOccupationHome ContactWork ContactCellphone NumberEmail AddressFamily Status(Please indicate with "X")Family StatusNot MarriedMarriedDivorced - Child stays with Mother/GuardianDivorced - Child stays with Father/GuardianOtherEmergency Contact/InfoName & SurnameRelation to ChildContact NumberName & SurnameRelation to ChildContact NumberPeople authorised for Pick Up(Please attach a copy of ID)Name & SurnameID NumberUpload fileDrag and Drop (or) Choose FilesName & SurnameID NumberUpload fileDrag and Drop (or) Choose FilesFinancial Information(Person responsible for account)Name & SurnameID NumberStreet AddressCityState/ProvinceZIP / Postal CodeHome ContactWork ContactCellphone NumberRelation to ChildUpload fileDrag and Drop (or) Choose FilesClass SelectionPlease indicate with an “x” the kind of service you would like to make use of. (Attached hereto also find the fee structure indication the relevant fees)Choose ClassBaby - Full DayBaby - Half DayToddler - Full DayToddler - Half DayEmail AuthorizationI authorize Edu P to contact me at the email addresses listed above for promotional purposes including but not limited to announcements, upcoming registrations, and new programs or class offerings. {checkbox-3}Do you authorize?YesNoCancellation PolicyEdu P requires one month’s notice (30 days) or one month’s payment in lieu/as a substitute of notice. If notice is given part way through the month, you will be charged in full for the following month. This allows us the necessary time to fill your spot. Please note registration fees are non refundable and are not applied towards the monthly fees owing.AcknowledgementConsent *I acknowledge that I have read the Standard Terms and Conditions applicable to Edupreneurtainment Preschool and bind myself thereto.DateSend Message
