Enrolment Form

Child Information:

Child's Name & Surname:

First Last

Nickname:

Date of Birth:

Child will be enrolled for:

Half Day

Full Day

Day-to-Day

How many days a week?

Please enter a number from 0 to 7.

Are you enrolling more than one child?

Yes

Additional Children

Row ID	Child's Name & Surname:	Nickname:	Date of Birth	Child will be enrolled for:	How many days per week?	Actions

There are no Entries.

Medical & Emergency Details

Emergency Contact Person:

First Last

Emergency Contact Number:

Doctor's Name:

Doctor's Phone Number:

Medical Aid:

Medical Aid Number:

Allergies / Medical Notes:

Mother's Information

Name & Surname:

First Last

Marital Status:

Single

Married

Widowed

Other

Paying Fees:

Yes

Other Marital Status:

Email Address:

Contact Number:

Alternative Contact Number:

Physical Address:

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Work Address:

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Father's Information

Father's Name & Surname:

First Last

Marital Status:

Single

Married

Widowed

Other

Paying Fees:

Yes

Other Marital Status:

Email Address:

Contact Number:

Alternative Contact Number:

Physical Address:

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Work Address:

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Agreement

The personal information submitted herein shall be solely used for your child’s appropriate education and to contact you in the case of an emergency. All the information submitted herein shall be used for the purpose stated above, as mandated by law. This information may be disclosed to EarthKids ECD practitioners as appropriate. Earthkids undertakes to ensure that appropriate security control measures are implemented to protect all the information to be submitted in this document.

Read through EarthKids Agreement

I have read and understood the agreement:*

I Agree

Parent/guardian signature:

Date submitted:

News Feed

What can tracks teach kids Preschool

How to Keep Children Safe Online

Baby school and other secrets is

Easy steps for choosing to the

Child Information:

Medical & Emergency Details

Mother's Information

Father's Information

Agreement