Lebone College Application Form – Fill Out and Use This PDF

SECTION B

PARENTAL/GUARDIAN/CAREGIVER INFORMATION

SECTION B(1)

Name of parent(s)/guardian(s)/caregiver(s) with whom the child lives (please specify Mr/Ms/Miss/Mrs/Dr/Revd)

Relationship to child: (eg. maternal grandmother, aunt, sister, mother, father)
Postal address:	Province:	Postcode:
Physical address: (where the child currently lives)
	Province:	Postcode:
Home tel:	Work tel:	Fax:
Cell:	Email:
Profession of parent(s)/guardian(s)/caregiver(s) with whom the child lives (please specify Mr/Ms/Miss/Mrs/Dr/Revd)
Name:	Name:
Surname:	Surname:
Profession:	Profession:
Employer:	Employer:

SECTION B(2) – To be completed only if the information is different from the information supplied in Section B(1) Name and surname of mother:

Postal address:	Province:	Postcode:
Physical address:
	Province:	Postcode:
Home tel:	Work tel:	Fax:
Cell:	Email:
Profession:	Employer:

SECTION B(3) – To be completed only if the information is different from the information supplied in Section B(1) Name and surname of father:

Postal address:Province:Postcode: Physical address:

	Province:	Postcode:
Home tel:	Work tel:	Fax:
Cell:	Email:
Profession:	Employer:

SECTION B (continued)

PARENTAL/GUARDIAN/CAREGIVER INFORMATION

Names of parents as given on the child’s Birth Certificate
Mother:			Father:
Mother’s date of birth:			Father’s date of birth:
(These dates are required as passwords for the telephone discussion of your child’s application)
Are the biological parents named above:	Married (to each other)					Partners (not married)					Widow/Widower
	Single						Divorced				Separated
Which parent(s), has legal responsibility for the child?			Both					Father			Mother

If the biological parents of the applicant are no longer together, please provide the name, address and telephone number of the parent who is no longer living at home. (Please note: This MUST be completed as written permission is required for the application. If a parent is deceased,

please ignore this section.)

Name:

Address:

Province:

Postcode:

Home tel:

Work tel:

Cell:

Is he or she aware of this application and given his/her permission?

Yes

No

If NO, please give reason:

Is the child an orphan?

Yes

No

Does the applicant have a biological brother/sister currently at Lebone II?

Yes

No

Grade:

House:

Please give the total number of dependent children in the family where the child lives (excluding the applicant)

Age:

School: (Government or Independent?)

Male

Female

School: (Government or Independent?)

Age:

Male

Female

School: (Government or Independent?)

Age:

Male

Female

SECTION C

EXTRAMURAL INTERESTS AND HOBBIES (eg. sport – rugby, tennis, soccer etc., reading, drama etc.)

ACHIEVEMENTS (eg. sport – teams, colours; academics; leadership roles; membership of societies etc.)

SECTION D

ADDITIONAL INFORMATION

Dietary Restrictions/Requirements:

Allergies:

Any other circumstances/needs which you would like to draw to our attention: (eg. health, family circumstances, allergies, etc.)

SECTION E

FINANCE

Details of person(s) responsible for all payments owed to Lebone II for this child.

Name:

Surname:

Home tel:

Work tel:

Fax:

Cell:Email:

Relationship to child:

I understand that Lebone II is an independent fee-paying school and that, in addition to the school fees, there will be other amounts due to Lebone II, such as, but not exclusive to, school uniforms, study materials, outings, extra activities, etc.

Signature of person(s) responsible for all payments

FINANCIAL ASSISTANCE

For those who wish to apply for financial assisitance, please complete the Means & Needs Application Form. Please submit the Means & Needs Application Form together with your Application Form in order to speed up the process.

SECTION F

DECLARATION

The information I/we have given on this form is correct and complete to the best of my/our knowledge and belief. I/we understand that I/we may be asked to produce relevant documents to support the information provided in making this application. I/we would like my/our child to take entrance assessments in the appropriate year of entry.

responsibility for the child even if they are living or working abroad.)

Signed:	Signed:
Print name:	Print name:
Date:	Date:

Email admissions to admissions@lebonecollege.co.za, or alternatively post admissions to PO Box 2623, Phokeng 0335, North West Province, South Africa.