Ezee Learning Centre

Enrollment Application Form

Complete the form below, sign digitally, and download your application to email to us at kayla@ezeelc.co.za

Student Information

Please provide details about the student

Full Name & Surname *

Date of Birth *

Gender *

Male

Female

Nationality *

Home Address *

City *

Province *

Zip Code *

Home Language *

Previous School (if any)

Enrollment Type *

Half Day

Full Day

Mother/Guardian Information

Name & Surname *

Phone Number *

Email Address *

ID Number *

Home Address *

Profession *

Employer's Name

Work Tel

Initials

Father/Guardian Information

Name & Surname *

Phone Number *

Email Address *

ID Number *

Home Address *

Profession *

Employer's Name

Work Tel

Initials

Guardian Information (If Applicable)

Only fill this section if there is a separate guardian

Name & Surname

Phone Number

Email Address

Relationship to Student

Emergency Contact Information

Contact Name *

Relationship to Student *

Phone Number *

Medical Information

Does the student have any allergies? *

Yes

Does the student have any medical conditions we should be aware of? *

Yes

Primary Physician Name

Physician Phone Number

Medical Aid Provider

Policy Number

Documents Submitted

Check the documents you will be submitting

Birth Certificate

Proof of Address

Immunization Records

Safety & Security

Are there any individuals who may not have contact with your child/ren?

Digital Signatures

Please sign below to confirm that all information provided is correct and you agree to the terms and conditions

Mother/Guardian Signature *

Father/Guardian Signature *

Declaration: I/We confirm that all the information provided is correct. I/We agree to meet financial responsibilities promptly and understand that incorrect information will render this application invalid. I/We agree to the terms outlined in the Payment of Fees, Notice & Termination, POPI Act, and Services Provided sections.

After downloading, please email the completed form to kayla@ezeelc.co.za