Admission

KHANYISA HIGH SCHOOL

BEHIND SHELL ULTRA CITY, MTHATHA, 5099

Telephone: 047 - 5371224
Fax: 047 - 5371962
Year: 2021

Note: This form must be completed in full. All changes to be initialed or signed by parent / guardian. Completing the form does not necessarily mean that the learner has been accepted into the school.

Grade Applied For:

Highest Grade Passed:

Year When Grade was passed:

Accession No:

Surname:

Initials:

Nick Name:

First Name:

Other Names:

Date of birth:

Gender:

Race:

Identification or Passport No:

Country of Residence:

Citizenship:

If SA, indicate province of residence:

Physical Address:

Home Telephone:

Emergency Telephone:

City/Suburb:

Learner Cell:

Code:

Learner Email Address:

Home Language:

Preferred Language of Instruction:

Boarder:

Deceased Parent:

Mode of transport:

Religion:

For Grade 1 only

Indicate pre-primary education:

Previous School Information

Name of Previous School:

Previous School Address:

Code:

Province:

Country:

Learner Medical Information

Medical Aid Number:

Medical Aid Name:

Medical Aid Main Member:

Doctor Name:

Doctor's Address:

Doctor Telephone Number:

Medical Condition:

Special Problems Requiring Counseling:

Dexterity of Learner:

Reg. Social Grant:

Rec. Social Grant:

Siblings

Number of other Children at this school:

Position in the family (e.g first):

Please supply full names below

Name:

Grade:

Name:

Grade:

Name:

Grade:

Parent / Guardian Information. Complete a SEPARATE parent form for each parent living at a different physical address

Title:

Initials:

Surname:

First Name:

Gender:

Home Language:

Race:

Identification Number Or Passport number:

Account Payer

Residential Street Address:

City/Suburb:

Code:

Occupation:

Surname of Spouse:

Occupation of Spouse:

Learner resides with this parent/s

Spouse ID Number:

Relationship to Learner:

Marital status of parent:

Correspondence Details

Title:

Surname:

Postal Address:

City/Suburb:

Code:

Other Contact Details

Home Telephone:

Work Telephone:

Fax Number:

Cell Number:

Spouse Work Telephone Number:

Spouce Cell Number:

E-Mail Address:

Spouse E-Mail Address:

I hereby declare that to the best of my knowledge, the above information as supplied is accurate and correct.

khanyisahighschool@gmail.com

047 150 0002

South Africa

KHANYISA HIGH SCHOOL

For Grade 1 only

Previous School Information

Learner Medical Information

Siblings

Please supply full names below

Parent / Guardian Information. Complete a SEPARATE parent form for each parent living at a different physical address

Correspondence Details

Other Contact Details

Quick Links