Krugersdorp High School Fees Form – Fill Out and Use This PDF

APPLICATION FOR ADMISSION TO

BOYS’/GIRLS’ HOSTEL : 2013

RECENT I.D.

PHOTOGRAPH

N.B. This form must be completed IN FULL by the applicant/parent(s)/guardian/foster parent(s), handed back to the school and must include the following :

1.One recent I.D. photograph.

2.A certified COPY of the latest school report.

3.A COPY of birth certificate/I.D. document

4.A copy of the confidential report from present school.

5.A copy of your MOST RECENT water and lights account.

6.A copy of main member of Medical Aid’s I.D. document and copy of Medical Aid Card.

7.Most recent payslip of both parents

8.If child is sponsored by guardian or trust fund, all documentation in this regard to be HANDED IN with the application form.

9.In the case of a rent/lease agreement, full details of landlord (name, address and telephone number) must be supplied.

WHERE POSSIBLE, PLEASE INCLUDE A TESTIMONIAL FROM CURRENT SCHOOL / PREVIOUS SCHOOL.

To be completed by the APPLICANT enrolling the child.

N.B. THE APPLICANT WILL BE RESPONSIBLE FOR PAYMENT OF HOSTEL FEES.

FEES ARE PAYABLE ON A TERMLY BASIS, IN ADVANCE.

MONTHLY PAYMENTS BY DEBIT ORDER ONLY.

The applicant(s) is/are the parent(s) / legal guardian / foster parent(s) of the learner. (Circle the appropriate category.)

I/We, the applicant(s), ________________________________ , I.D. number : ____________________

________________________________, I.D. number : ____________________

do hereby apply for the admission of ____________________________________ (full name of learner) to reside in

the Krugersdorp High School BOYS’/GIRLS’ Hostel. (Circle appropriate hostel).

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1.PARTICULARS OF LEARNER

SURNAME :	________________________________________________________________
FIRST NAMES :	________________________________________________________________
GENDER :	______________________ DATE OF BIRTH : ________________________

PRESENT SCHOOL : _____________________________________ PRESENT GRADE : ____________

CURRENT SCHOOL TELEPHONE NUMBER: _______________________________________________

RESIDENTIAL ADDRESS OF LEARNER : __________________________________________________

______________________________________________________________________________________

DOMESTIC BACKGROUND : Own Parents / Parents Separated / Parents Divorced / Father Deceased / Mother Deceased / Father remarried / Mother remarried / Foster Parent(s) /Legal Guardian (Circle that which is applicable) This information will help us understand the factors which may influence your child’s performance at school. It will

be treated in the strictest confidence. In the case of foster parents/legal guardianship, a copy of legal documentation is required.

RESIDES WITH : Mother / Father / Both Parents / Guardian / Foster parents (circle that which is applicable)

Have you made any previous applications to K.H.S.? _____________

Do you have any siblings (brothers / sisters only) attending K.H.S.?

NAME	GRADE

2.REASON FOR APPLICATION TO THE HOSTEL :

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

3.PARTICULARS OF PARENTS

SURNAME (Parent) :	_____________________________ / _____________________________
FIRST NAMES (Parent) :	_____________________________ / _____________________________
I.D. NUMBER :	_____________________________ / _____________________________
ADDRESS (Home) :	_____________________________ / _____________________________
	_____________________________ / _____________________________
	____________Postal Code : ______ / ___________Postal Code : _______
(Postal) :	_____________________________ / _____________________________
	_____________________________ / _____________________________
	____________Postal Code : ______ / ___________Postal Code : ________
All correspondence to be addressed to home / postal. (Circle appropriate choice)
TEL. NO. Home :	__________________________/ __________________________
Work :	__________________________/ __________________________
Cell :	__________________________/ __________________________

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OCCUPATION :	_____________________________ / _____________________________
BUSINESS NAME :	_____________________________ / _____________________________
BUSINESS ADDRESS :	_____________________________ / _____________________________
	_____________________________ / _____________________________
	___________Postal Code : ______ / ___________Postal Code : _______
Email address :	__________________________ / __________________________

4.Name and telephone number of two (2) friends or relatives to be contacted if we are unable to contact the parents/guardians.

____________________________________________________________________________

_____________________________________________________________________________

5.TWO FINANCIAL REFERENCES OF PERSON RESPONSIBLE FOR HOSTEL FEES (to be completed in full, as these will be verified). If fees are to be covered by a Trust Fund, please indicate this and provide proof of this Fund.

Business Name : _____________________________________________________________________

Branch where account is held : ______________________ Tel. No : ________________________

Account No : _______________________ in the name of : _________________________________

Outstanding balance : _________________ Monthly payment : _____________________________

For Office Use Only :

Date contacted : _______________________ Contact person : _____________________

Rating : _________________

Business Name : _____________________________________________________________________

Branch where account is held : ______________________ Tel. No : ________________________

Account No : _______________________ in the name of : _________________________________

Outstanding balance : _________________ Monthly payment : _____________________________

For Office Use Only :

Date contacted : _______________________ Contact person : _____________________

Rating : _________________

6.EXTRAMURAL ACTIVITIES

I object/have no objections (circle which is appropriate) to ______________________________ (full names of

learner) reasonably participating in the extramural activities offered by the hostel.

I acknowledge that __________________________ must participate in at least one extra mural activity offered by

the school per term.

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7.TRANSPORT

I am aware that the hostel is closed during weekends and school holidays and that it is my responsibility to provide transport for my child to and from the hostel at my own expense.

8.MEDICAL TREATMENT

Hostel fees do not cover the cost of medical treatment. The hostel staff take care of home nursing to the best of their ability. Parents, however, will be responsible for further medical care.

In the event of illness or an accident where, in the opinion of the responsible officer, immediate medical treatment will be necessary for a child, the hostel staff will arrange for such treatment after attempting to contact the applicant. The applicant will be responsible for medical costs incurred.

Medical Aid : ________________________________________ No.: __________________________

State any medical particulars to be noted about the learner : __________________________________

___________________________________________________________________________________

9.HOSTEL RULES AND REGULATIONS

I am aware that the learner’s admission is subject to the rules and regulations of the hostel. I am prepared to comply with these and :

•Undertake to pay the hostel fees termly, in advance.

•Acknowledge that the school will not be obliged to permit the learner to take up residence in the hostel unless such fees have been paid in full.

•Acknowledge that should I default with any payment, the admission of the learner will immediately terminate and the learner may be excluded from any further residence and may, in some cases, have to leave the school.

•Agree to a term’s notice in writing before I remove the learner from the hostel. Should the learner be outside the school feeder area, he/she will lose his/her place in the school as well.

•Acknowledge that if such notice is not given, I will remain liable for a full term’s fees.

•Agree to compensate for any damage to hostel property caused by the learner.

•Acknowledge that the school and/or hostel and/or staff will not be held liable for any damages of whatever nature that may result from any injury that my child may sustain in whatever manner while being involved in any sport and/or extramural and/or any other activities.

•Acknowledge that while the learner is resident in the hostel, control and discipline of the learner will be exercised in accordance with law and with lawful prescriptions, and in accordance with the Constitution of the school where appropriate, and in accordance with hostel rules, and I consent to the application of such disciplinary measures without further authorisation from me.

•Acknowledge that the school will be entitled to exercise control and discipline of the learner within the school and be entitled to have the learner removed from the hostel.

•Acknowledge that the hostel and staff thereof cannot be held liable for any loss of personal articles incurred by the learner while the learner is in residence at the hostel.

10.UNDERTAKING BY APPLICANT

I undertake to notify the hostel and school immediately of any change in the above information.

I fully understand that the hostel/school cannot be held responsible for any loss of personal belongings of the learner, be it through neglect or theft.

HAVING READ AND ACCEPTED THE ABOVE UNDERTAKING, RULES AND REGULATIONS, I CERTIFY THE INFORMATION FURNISHED ABOVE TO BE TRUE AND CORRECT.

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SIGNATURE OF APPLICANT(S)	DATE

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FOR OFFICE USE ONLY

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THIS PAGE MUST NOT BE RETURNED TO SCHOOL

Please note that this fee structure is likely to change for 2013.

FEE STRUCTURE : 2012

The school fee structure is as follows.
SCHOOL FEES
School fees per learner		R17 500,00
New pupil fees		R500,00 (paid in advance but forms part of the R17 500)
Per Term		R4 375,00		(Paid in advance)
Per Month		R1 750.00		(10 months)
Discount Structure
10% if paid in full by the end of FEBRUARY		R15 750,00	(R1 750,00)
Methods of Payment
•	Debit Order		• Cheque (post dated accepted)
•	Credit Card		•	Internet/Direct Bank Deposits

•Cash

HOSTEL FEES
Hostel fees per learner	: R25 500,00
1st Term	2nd Term	3rd Term	4th Term
R7 650,00	R7 650,00	R5 100,00	R5 100,00

Per Month : R2 550,00 (10 months) by Debit Order only

Should a learner join the hostel in the 3rd or 4th term, the fee will be R6 500,00 per term.

Daily Boarders : R9 800,00 per annum (R2 450,00 per term or R980,00 per month)

Discount Structure : Please note that due to the fact that we are working on a very tight budget, no discount for advance payments in hostel fees will be given.

ALL FEES ARE PAYABLE ON A TERMLY BASIS IN ADVANCE.

MONTHLY PAYMENTS BY DEBIT ORDER ONLY, OR AS OTHERWISE ARRANGED.

ALL FEES ARE TO BE PAID IN FULL BY 31 OCTOBER 2012.

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