jam ’eyyatul qurra’ institute enrolment application form€¦ · erf392 thirteenth avenue,...

ERF392 Thirteenth Avenue, Schaapkraal

PO Box 31447, Grassy Park 7888

Tel: 021 007 3368, Fax: 021 704 1305

Email: [email protected], Web: www.jeq.co.za

PBO: 930055981, NPO: 012 - 911

ERF392 Thirteenth Avenue, SchaapkraalTel: 021 007 3368, Email: [email protected]

FEMALE HIFTH INSTITUTEERF236, Kraal Road, SchaapkraalTel: 021 703 9324, Email: [email protected]

MALE HIFTH INSTITUTEERF392 Thirteenth Avenue, SchaapkraalTel: 021 007 3368, Email: [email protected]

PREPARATORY SCHOOLERF675, Thirteenth Avenue, SchaapkraalTel: 021 007 3368, Email: [email protected]

PRE-PRIMARY SCHOOL

Jam ’Eyyatul Qurra’ Institute Enrolment Application Form

Dear Parent/ Guardian

We are delighted that you have chosen to apply to Jam ’Eyyatul Qurra’ Institute. We will do our best to ensure that we make the application process as smooth as possible.

In order to achieve this, kindly note the following:

• Please read your application form carefully and ensure that all information is completed in full.•Pleaseensurethatcopiesofallcertifieddocumentsandotherformsrequestedareattached.Nocopieswillbe

made at the school.•Allcertifiedcopiesmustnotbeolderthan3months.•Pleasebeadvisedthatanyapplicationnotcomplyingwiththeabovewillbediscardedwithoutnotification.• Please be advised that submission of an application form does not constitute automatic acceptance for

enrollment.• If you have not been contacted by the school by the end of June, please kindly accept that your application has

not been successful.• If any information is withheld JEQ will reconsider the application. • Interviews will be held with both parents including parents who are separated.

The following documentation must accompany the application form:

Certifiedphotocopyoflearner’sbirthcertificateorIDdocument oCertifiedphotocopyoflearner’slatestreportorAcademicprogress oCertifiedphotocopyoflearner’svaccinationrecords/cliniccard oIFNOTASACITIZEN:Proofofimmigrantstatusandvalidpermitofapplicant andparents/guardians(Certifiedcopies) oCertifiedphotocopiesofParents’/LegalGuardian’sIDdocument oCopyoflatestutilities(municipalaccount)asproofofaddress o

LegalProofofGuardianship(forapplicationsbyaguardian) oTworecentIDcolourphotosofthelearner oSignedCodeofConduct&Consentform(SectionF) oSignedFinancialAgreementandConsentofverification(SectionG) oSignedDeclarationbyParents/Guardians(SectionH) oSignedcopyofthehomeschoolingform(whereapplicable) o

*** PLEASE USE BLOCK LETTERS AND FILL IN CLEARLY***

Yours in Education

Nadiema BenjaminPrincipal of Pre-primary and PreparatorySchools

Achmat SiersPrincipalofMaleHifthInstitute

Suleiman BenjaminPrincipalofFemaleHifthInstitute

1.1. Contact details

School Contact Number Physical Address Email Address Contact Person

JEQ Pre-primary School

0210073368 Erf675ThirteenthAvenue,Schaapkraal

[email protected]@jeq.co.za

NadiemaBenjamin(Principal)

JEQ Preparatory School



NadiemaBenjamin(Principal)

JEQFemaleHifthInstitute



SheikhSuleimanBenjamin(Principal)

JEQMaleHifthInstitute

0217039324 Erf236KraalRoad,Schaapkraal


SheikhAchmatSiers(Principal)

1.2. Enrollment details

IwouldliketoenrolmychildtocommenceinTerm_____of20_____in:(please tick below)

JEQPre-primarySchool Grade0 GradeR

JEQPreparatorySchool Grade1 Grade2 Grade3

JEQFemaleHifthInstitute

JEQMaleHifthInstitute

Office use only

LearnersBirthCertificate

ID(Father) ID(Mother) Learnerreport

Proof of address Clinic card Deathcertificate(ifapplicable)

Divorcecertificate(ifapplicable)

Financial agreement&Creditverification

CodeofConduct&Consent

CreditVerification Declarations

Date received: Interviewer:

Accepted: Grade:

Admission fee paid: Receiptnumber:

Studentnumber: Family code:

Date captured on learner database:

A Section AInformation and Contact Details

of 14 |JEQLearnerApplication|SectionA:InformationandContactDetails

Please use block letters and fill in clearly.

PASTE CHILD’S PHOTO

HERE

2. 1. Learner’s personal details

Surname

Full name/s

Gender Male Female Date of birth

Country of birth

SouthAfricancitizen Yes No ID / Passport number

Nationality Visa/ Permit expiry date

Homelanguage Religion

Numberofchildreninfamily Is1st,2nd,3rdchildinfamily

Are there any other siblings at JEQ? Yes No If yes, please supply names and grades below:

Housedoctor Telephone

Doctor’s Address

2. 2. Home address

Address

Suburb City Postal code

Telephone Email

2. 3. Postal address

Sameashomeaddresso

Address


2. 4. Details of the child’s current school (block letters and fill in clearly please)

School Principal

Address

Telephone Fax

Email

Current grade

of 14 |JEQLearnerApplication|SectionB:PersonalDetailsofLearner

B Section BPersonal Details of Learner


3. 1. Learner is staying with

Bothparents(Please complete section 3.2 and 3.3) oMother (Please complete section 3.2) oFather (Please complete section 3.3) oGuardian (Please complete section 3.4) oMarital status: Married o Widowed o Divorced o Separatedo Single o

3. 2. Father’s details

Surname

Full name/s

Country of birth Date of birth




Address


Telephone Email

Occupation

Work Address


WorkTel Fax

3. 3. Mother’s details

Surname

Full name/s

Country of birth Date of birth




Address


Telephone Email

Occupation

Work Address


WorkTel Fax

C Section CParent/ Guardian Details

of 14 |JEQLearnerApplication|SectionC:Parent/GuardianDetails


of 14 |JEQLearnerApplication|SectionC:Parent/Guardiandetails

C Section CParent/ Guardian details

3. 4. Guardian’s details

Organisation

Surname

Full name/s

Gender Male Female Date of birth

Country of birth




Address


Telephone Email

Occupation

Work Address


WorkTel Fax

3. 4. Emergency contact details

Surname

Full name/s

Relationshiptolearner

Address


Telephone Email

Occupation

Work Address


WorkTel Fax

Please be advised of the importance of the above information. Any changes must be reported to the school immediately. In the case of an emergency, should your contact details have changed and you cannot be contacted, JEQ cannot be held responsible in any way for any costs incurred, should your child/children be in need of urgent medical attention.

If parents are divorced/ separated please tick where appropriate

Person(s)towhomaccountsshouldbesent: Fathero Mother o Guardian oPerson(s)towhomcorrespondenceshouldbesent: Fathero Mother o Guardian o Person(s)towhomreportsshouldbesent: Fathero Mother o Guardian o


D Section DLearner Profile (for School records only)

of 14 |JEQLearnerApplication|SectionD:LearnerProfile(Forschoolrecordsonly)

4.1.Child’sname:_______________________________________________________________________________________________________

4.2.Whoarethelegalguardiansofyourchild:________________________________________________________________________

4.3.Ifthereareanyrelevantlegaldocumentationweshouldhave,pleasegivedetailsandprovideacopywiththe application.

Example-Guardianship,BarringOrders,Access,etc_________________________________________________________________

4.4.Medicalconditionsweshouldknowabout: SpeechoHearingoSightoOtherbarrierso4.5.Medicalconditions: Asthmao Epilepsy o Heartconditionso Diabetes o Othero

4.6.Allergies:___________________________________________________________________________________________________________

___________________________________________________________________________________________________________________________

___________________________________________________________________________________________________________________________

___________________________________________________________________________________________________________________________

___________________________________________________________________________________________________________________________

4.7.Emotionalproblems:______________________________________________________________________________________________

___________________________________________________________________________________________________________________________

___________________________________________________________________________________________________________________________

___________________________________________________________________________________________________________________________

___________________________________________________________________________________________________________________________

___________________________________________________________________________________________________________________________

4.8.Laterality: RighthandedoLefthandedo Mixed o

4.9.Additionalinformation:Pleasegivedetailsandspecifyanyconditionnotlistedabovewhichmightbeconsideredtoaffectthechild’sabilitytobenefitfromschool.Ifthereareanymedicalreportsinrelationtoany of the above, please attach it to the application.

______________________________________________________________________________________________

___________________________________________________________________________________________________________________________

___________________________________________________________________________________________________________________________

___________________________________________________________________________________________________________________________

___________________________________________________________________________________________________________________________

___________________________________________________________________________________________________________________________

4.10.Doesyourchildrequireanyregularmedication: Yeso NooIf yes, please provide details below:

_________________________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________________________


of 14 |JEQLearnerApplication|SectionD:LearnerProfile(Forschoolrecordsonly)

D Section DLearner Profile (for School records only)

4.11.Doesyourchildshowanybehaviouralchallenges:____________________________________________________________________

____________________________________________________________________________________________________________________

___________________________________________________________________________________________________________________________

___________________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________________________

4.12.Didyourchildattendplayshooland/otherschool:YesoNoo

Nameofplayschool:________________________________________________________Dates:________________________________________

Nameofotherschool:______________________________________________________Dates:________________________________________

4.13.Arethereanyissuesyouthinktheschoolmayneedtoknow?_______________________________________________________

_________________________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________________________

4.14.Doesyourchildhaveanyeducational,physical,emotionalorlanguageneeds?_____________________________________

_________________________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________________________

4.15.Hasyourchildeverbeenassessedforanyreason? Yeso Noo

4.16.Ifyes,arereportsavailable? Yeso Noo

4.17.Hastherebeenanymajortraumainyourchild’slife?Yeso Noo

If yes, please provide details below:

_________________________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________________________

________________________________________________________________________________________________________________________________


E Section EExtra-mural Activities

of 14 |JEQLearnerApplication|SectionE:Extra-muralActivities

5.1. Extra-mural Activities for Hifth Institutes

Itisarequirementthateverylearnerparticipateinextra-muralactivities,societiesandsport.(please tick below)

Male Hifth Institute Female Hifth Institute

Kickboxing Kickboxing

Art Art

Soccer Sewing

Netball

Archery

5.2. Extra-mural Activities for Preparatory and Pre-primary school

Pre-Primary (Grade 0 - R) Preparatory (Grade 1 - 3)

Soccerstars EuropaSoccer

Karate Karate

Action ball Action ball

Curious cubs Curious cubs

Cullinary kids

* Please note PPS and PS learner’s activities are done during school hours and provided by independent service providers at an additional cost.

5.3 Complete the questions below if you have participated in any of the below activities:

I have participated in the following extra-mural activities, societies and sport at my previous schoolIndicatehighestgroupe.g.RugbyU12

_________________________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________________________

StatewhetherProvincialselectionandwhichsportandagegroup

_________________________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________________________

IhaveachievedthefollowingLeadershippositions(indicateyearachieved)e.g.Prefect,teamcaptain,etc

_________________________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________________________

Itakepartinthefollowingactivitiesoutofschoole.g.Hobbies,Interestsetc

_________________________________________________________________________________________________________________________________

________________________________________________________________________________________________________________________________


6.1. School Policy Agreement

1. IundertaketoadheretotheSchoolSpecificPoliciesandCodeofConduct.2. ThesedocumentsareamendedfromtimetotimeandavailableontheofficialSchoolwebsite(jeq.co.za).3. Iundertaketorecognisetheauthorityandresponsibilityoftheschooltomaintaindiscipline(legallyteachersarein

locoparents)andacceptthatonoccasionitmaybenecessarythatthismayincludedisciplinarymeasuresagainstmy child.

4. Iundertaketoallowmychildtouseschooltransportasandwhenneededandindemnifytheschoolandthestaffagainst liability in this regard.

5. Iacceptthatmychildwilltakepartinextra-muralactivities,societiesandsportatJEQandacknowledgethattheinability to arrange transport cannot be used as a reason for non-participation.

6. Iacceptthatinthecaseofanemergencytheschoolwillendeavourtocontacttheparents/guardian,failingwhichtheschoolwillcontactthedoctorlistedonpage3.Anycostswillbecoveredbytheparents/guardian.

If you disagree with any clause please indicate:

_________________________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________________________

________________________________________________ ________________________________________________Parent/Guardiansignature Learnersignature(Age9orolder)

________________________________________________ ________________________________________________Date Date

NON-SOUTH AFRICAN CITIZENS: All necessary documentation indicating the status of Parents and the Applicant must be provided. All documentation must be valid and may not exceed the expiry date.

ACCESS OF INFORMATION I duly authorise Jam ’Eyyatul Qurra’ Institute to obtain any information pertaining to my child from a previous school/s which my child has attended.

DECLARATION BY PARENT/S OR GUARDIAN I hereby declare that all information contained in this application is accurate in every manner.

________________________________________________Parent/ Guardian signature

________________________________________________Date

of 14 |JEQLearnerApplication|SectionF:CodeofContentandConsent

F Section FCode of Conduct and Consent


7.1. Financial Agreement

Financial commitment to Jam ‘Eyyatul Qurra’, by:

_________________________________________________________________________________________________________________________________(Name and Surname of Parent/Guardian)

_________________________________________________________________________________________________________________________________(Name and Surname of Learner)

I/We, as a parent/guardian of the above mentioned child, acknowledge that I am familiar with the admission requirementsofJam’EyyatulQurra’Institute,whichincludesthestatutoryobligationtopayschoolfeesasdetermined by the parents of Jam ’Eyyatul Qurra’ Institute and implemented by the Management Committee of Jam ’Eyyatul Qurra’ Institute.

IconfirmthatIshallpaythe‘newapplicantfee’asdeterminedbytheJam’EyyatulQurra’InstituteFinancialCommittee.

I permit Jam ’Eyyatul Qurra’ Institute to do a credit check should my Child’s school fees be in arrears are outstanding.IacknowledgethatIhavereadandunderstandthefollowing.IntermsoftheSouthAfricanSchools’Act:(a)Biological/adoptiveparentsarejointlyandseverallyliableforthepaymentofschoolfeesirrespectiveoftheir

marital status.(b)Intheeventofnon-paymentofschoolfeestheschoolwillinstitutelegalactionagainstbothparentsirrespectiveof

maintenance and court orders which may exist between the parties.(c)IntermsofSection40and41oftheSouthAfricanSchools’Act,theschoolmayenforcethepaymentofthese

compulsory fees.(d)Intheeventoftheschoolhavingtotakelegalactionfortherecoveryofschoolfees,alllegalcosts,including

attorney/client fees and collection costs incurred by the school will be charged to the parent’s account.

Nameaccountshouldbeaddressed to

IdentityNumber

E-mail Address

Physical Address

PLEASE NOTE: Theschoolpolicyallowslearnerstoparticipateinactivitiesatcosttoparent/guardian,exceptinthecase of “extras” e.g. grade social activities or tours. In these cases parents must ensure that school fees are up to date, for the learner to participate.

________________________________________________ ________________________________________________Parent/ Guardian signature Date

G Section GSchool Finances

of 14 |JEQLearnerApplication|SectionG:SchoolFinances


7.2 Consent of credit verification

Notethismustbecompletedbybothparentsorguardian/s.

Parent 1/ Guardian 1

Surname

Full name/s

ID number

Parent 2/ Guardian 2

Surname

Full name/s

ID number

I/Weherebyauthorise/consenttoverificationsbeingconductedonmyself/ouselvesintheeventthatmy/ourJam‘Eyyatul Qurra’ fee account is handed over for the collection of the outstanding fees.

I/Weunderstandthatallinformationverifiedbythecollectionagency/attorneywillbeplacedonits’databasesandwill be made available solely for the use of the collection agency/ attorney and associates in collecting all outstanding debt on behalf of Jam ’Eyyatul Qurra’ Institute inclusive of all costs and interests.

I/We accept that in the event that we fail to make payment promptly on or before the due date as set out in the annual feesletter,TheJam’EyyatulQurra’Instituteshallhavetherighttodemandtheimmediatepaymentofthetotalamount owing to the school by handing the account over for debt collection.

I/We further accept that in such circumstances we shall be liable for the payment of all legal fees on the attorney and the client scale of costs, including collection commission and interest incurred by Jam ’Eyyatul Qurra’ Institute in demanding and enforcing compliance with the parents obligations in terms hereof. In such a case, both biological parents and/ or legal guardian’s personal information will be disclosed to the collection agency/ attorney in order for the fees to be collected successfully.

I/Weacknowledgethatnon-payingparentscanbelistedasdefaulterswithcreditinformationbureaus.ThecollectionagencywillsendtheparentsaletteronbehalfoftheschoolviathepostaswellasnotificationsviaSMSoremail.TheoverdueschoolfeesarestilldueandpayableifapersonislistedonanyCreditBureau.

Thisoptionwillbeusedwhennon-payingparentsdonotrespondtoJam’EyyatulQurra’Institutefeestatements,finalnoticesforpaymentandemails/telephonecallsrequestingpaymentoffees.

IntermsofFamilyLawandtheSASchoolsAct,parentsarejointlyandseverallyliableforthepaymentoftheschoolfees irrespective of their marital status. In the event of non-payment of school fees, the school will sue or list both parents irrespective of maintenance and court orders which may exist between the parties. I Me hereby acknowledge these terms.

________________________________________________ ________________________________________________Parent 1/ Guardian 1 signature Parent 2/ Guardian 2

________________________________________________ ________________________________________________Date Date

of 14 |JEQLearnerApplication|SectionG:SchoolFinances

G Section GSchool Finances


H Section HDeclaration by Parents/ Guardians

of 14 |JEQLearnerApplication|SectionH:DeclarationofParents/Gaudians

8.1. Educational Screening Tests

Duringyourchild’stimeinJam‘EyyatulQurra’Institutehe/shewillundergovariousEducationalScreeningTests(ifrequired).

Shouldmychildrequireeducationalscreeningtestingduringhis/hertimeinJam‘EyyatulQurra’Institute,Igivepermission for these tests to be carried out.



8.2. Discipline /Protocol For Challenging Children

Child’sName:_______________________________________________________________________________________________________________

Iundertaketosupport,co-operateandcarryoutJam‘EyyatulQurra’SchoolPoliciesintheinterestofandthewelfareofthewholeschoolcommunity.Mychildwillweartherequiredschooluniformandonextra-muraldayswillweartheextra-mural uniform. I further undertake to change the details on this form if and when the need arises.




of 14 |JEQLearnerApplication|SectionH:DeclarationofParents/Gaudians


8.3. Internet Permission

IhavereadtheInternetAcceptableUsePolicyonthewebsiteandgrantpermissionformychildtoaccesstheinternet.UnderstandthatschoolInternetusageisforeducationpurposesonlyandthateveryreasonableprecautionwillbetaken by the school to provide for online safety. I accept my own responsibility for the education of my child on issues of internet responsibility and safety. I understand that having adhered to all the enclosed precautions, the school cannot be held responsible if my child tries to access unsuitable material.



8.4. Photographs of Students

Theschoolmaintainsadatabaseofphotographsofschooleventsheldoveryears.Ithasbecomecustomarytotakephotos of students engaged in activities and events in the interest of creating a pictorial, as well as historical record oflifeattheschool.Learnerphotographsmaybepublishedonourschoolwebsiteorinbrochures,yearbooks,newsletters, local and national newspapers and similar school-related productions. In the case of website photographs, student names will not appear on the website as a caption to the picture. If you or your child wish to have his/her photograph removed from the school website, brochure, yearbooks, newsletters etc. at any time, you should write to the school principal.

Consent:If you are happy to have your child’s photograph taken as part of school activities and included in all such records, tick here o





of 14 |JEQLearnerApplication|Section8:DeclarationofParents/Gaudians

8.5. Declaration of commitment

I/ We hereby declare that we will: 1.manageandtakeresponsibilityofmychild’sHomeProgrammeissuedbytheschool;2. daily sign and check the Quraan Monitoring book which is a communication book between the parent and the class teacher;

3.checkmychild’sQuarterlyProgressReport,signitandreturnittotheschool;4.checkdailyifthereareanyparentnoticesthatareissuedbytheschool;5.attendallschoolandprogressmeetingswhicharerequiredbyparents;6.supportschoolfunctionsandfundraisingeventsthattheinstitutionhosts.

A. Is there a service which you can render or any items which you can donate or assist the school with in your personal capacity? Please specify...

_____________________________________________________________________________________________________________________________

B. Pleaseindicateyourfieldofexpertise:

MOTHER__________________________________________________________________________________________________________________

FATHER__________________________________________________________________________________________________________________

C. WouldyouliketoserveonourParentBody?Yes:oNo:o



8.6. Declaration by the parent/ guardian

I/We do hereby declare that all of the above information supplied is true and correct. I undertake to inform Jam‘Eyyatul Qurra’ Institute immediately should any of the above information change for whatever reason. I have readthe Application for Admission Form in full and totally understand the contents and I accept, without prejudice, all thetermsconditionsstatedtherein.IdoherebydeclarethatI/wehavebeenadvisedthatintheeventofextremefinancialrestrictions,applicationforpartialorfullexemptionmaybeappliedfor.Applicationmustbemadebeforethe31stMarch for consideration.




jam ’eyyatul qurra’ institute enrolment application form€¦ · erf392 thirteenth avenue,...

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