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Noah's Arch

Noah's Arch DAY AND NIGHT CARE CENTRE

Enrolment Form

REGISTRATION NO: 325-354 NPO
Address: 44 6th Avenue, Orange grove, 2198 | Phone: 063 150 5490 | Email: info@noaharch.co.za

Child's details

Detail of your child to be completed by parent or guardian

Name: Preferred name: Surname:

Gender:
M F

Child's date of birth (yyyy/mm/dd): Child's ID number / passport:

Primary Caregiver Details

(this caregiver is responsible for payment of school fees)

First name:

Surname:

Relationship status:

Marital status:

ID number:

Cellphone number:

Whatsapp number:

Email address:

Home address:

Secondary Caregiver Details

First name: Surname: Relationship status: Marital status:

ID Number: Cellphone number: Whatsapp number: Email address:

Home address:

Additional Caregiver

(This person may collect this child from school)

First name and surname:

Phone number:

SASSA Details This home qualifies for and receives a SASSA Grant:
Yes No

If yes, please provide a copy of your SASSA Card: (Max 2MB)

Medical Information 1. Provide a copy of clinic immunization card
2. Ensure that your child is up to date on all immunization

Doctors name:

Doctors contact number:

Please list any known allergies:

Has your child had any serious operations or illnesses? Please provide details:

Has your child got any physical disabilities or special needs? Please provide details:

Is there anything else that we should know about your child medically?:

Educare Centre Agreement

This agreement is made by and between Noah's Arch and the Parent / Caregiver of . The following has been agreed upon between the two parties beginning .

Please tick:

I/We confirm that all the above is correct at the time of completing the form.

I/we agree that, if any of the information (cell numbers, contact detail, medical information) changes we will inform Noah's Arch Educare Centre immediately.

I/we agree to the monthly school fee rate of R

I/we agree that the fee will be paid by the day of each month. Our arrival time will be am. Our pick up time will be no later than pm on Mondays to Thursdays. Our pick up time will be no later than pm on Fridays. Any added time before or after those times will be charged early arrival/late pick up fee of R per hour.

Indemnity

I, The parent / legal caregiver of hereby give permission for him/her to participate in all the activities of Noah's Arch including sports, games and any other school-related activities.

I understand that the centre will take all reasonable steps to keep my child safe. I agree to be responsible for any medical and/or hospital costs if my child is injured.

I agree to release and not hold responsible the Principal, teachers, staff, helpers, or students of Noah's Arch for any loss, damage, or injury to my child or my child’s property, except if it is caused by gross negligence or intentional harm.

I also give permission for the Principal or teacher to make decisions regarding medical treatment or surgery for my child in case of an emergency. As far as I know, my child is in good health.

I agree to the Indemnity conditions above.

Protection of Personal Information

Your privacy is very important to us, and all Personal Information collected will be handled in a lawful, justifiable and reasonable manner. We will be as open and transparent as possible with you as to how your Personal Information is handled. For the purposes of this enrolment form, Personal Information is any form of information that is identifiable with you or , may include but is not limited to name, mailing address, phone number, email address, nationality, and medical history.

We generally process your Personal Information for the following purposes:

the operation of an early learning centre;
to provide and maintain a mobile application suite for communication and resource-sharing;
to provide interactive features for your use;
to provide support;
to gather analysis or valuable information so that we can improve our operations;
to monitor the usage of the mobile application suite;
to detect, prevent and address technical issues;
in any other way described when you provide the information;
to respond to an e-mail that you have sent to us by return e-mail or by phone;
to contact you from time to time, where you have consented to being contacted for marketing purposes or to be put on our mailing list;
for such other purposes to which you may consent from time to time; and for such other uses which we are authorized by law to carry out.

By signing this acknowledgment and consent form:

you confirm that you have read and understood the privacy policy and this form.
you acknowledge, accept and agree that you have given us your consent to the collection, use, disclosure and related processing of your Personal Information as outlined above.
you understand that your consent is voluntary and that you are free to withdraw your consent on written notice to us.

Signed at (place):

On the day of (date):

Parent / Caregiver Name:

Parent / Caregiver ID number:

Parent / Caregiver Digital Signature:

Witness name:

Witness Digital Signature:

Documents required (Please tick & upload) Copy of Parents/Guardian's ID (Max 2MB)

Birth certificate of child (Max 2MB)

Clinic card of child (Max 2MB)

SASSA card (if applicable) (Max 2MB)

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Noah's Arch DAY AND NIGHT CARE CENTRE

Enrolment Form

Enrollment Application Received!