APPLICATION FOR ADMISSION TO ATC

Website : www.angelstutorcentre.co.za
Registrations: registrations@angelstutorcentre.co.za Admin: admin@angelstutorcentre.co.za
Office: 021-5587211 | Mobile: 061 1736216 | Principal: 061 4265459
Application for Admission
This application is subject to acceptance by Angels Tutor Centre (Pty) Ltd
YOUR CHILD
Surname
First names
Sex Date of birth
Religion
Child’s ID number
Home address
Home language Other language(s)
Nationality Race
Is your child adopted? Child’s weight
Child’s height
Anticipated starting date To start in grade
Do you require aftercare?
MOTHER/GUARDIANMOTHER/GUARDIANMOTHER/GUARDIANMOTHER/GUARDIAN
ID number Surname
First name(s)
Married/divorced/separated/widowed?
Home address

Application is subject to acceptance by ATC Page 2
Profession, business, occupation
Name and address of employer
Telephone number home WorkWorkWorkWork
Mobile EEEE----mailmailmailmail
FATHER/GUARDIAN
ID number Surname
First name(s)
Married/divorced/separated/widowed?
Home address
Profession, business, occupation
Name and address of employer
Telephone number home WorkWorkWorkWork
Mobile EEEE----mailmailmailmail
Status of parents Living together Living apart (cross applicable box)
With whom does your child reside
Who may collect your child?
If anyone other than the people listed on this form are collecting your child, the school must be notified prior toIf anyone other than the people listed on this form are collecting your child, the school must be notified prior toIf anyone other than the people listed on this form are collecting your child, the school must be notified prior toIf anyone other than the people listed on this form are collecting your child, the school must be notified prior to
collection in writing or via telephone by one of the parents or guardian.collection in writing or via telephone by one of the parents or guardian.collection in writing or via telephone by one of the parents or guardian.collection in writing or via telephone by one of the parents or guardian.
Who does your child stay with in your absence? Grandparent Other relative
Friend Paid sitter
Nanny Other
Additional members of the household
Please provide contact telephone numbers

OTHER SIBLINGS IN THE FAMILY
Name Date of birth
Relation Position in family, ie eldest
Name Date of birth
Name Date of birth
EMERGENCY CONTACT DETAILS (Other than parents)
Name Relationship
Contact number Alternative number
DOCTOR
Name Contact number
Does your child suffer from any allergies, asthma, colour blindness, epilepsy, etc?
In case of emergency, which hospital may your child be taken to?
Please include a copy of your Medical Aid card, front and back
Please sign consent for your child to be administered first aid and
or to call on medical advice or assistance in case of an emergency.
Signatures of parents/guardians
Mother/Guardian Father/Guardian
Print Names
Date ____________________________________

SPEECH
Any speech difficulties observed?
If more than one language spoken, what other languages are spoken?
Does your child use immature or incomplete sentences?
Does your child stutter?
At what age did your child start to talk?
SOCIAL & EMOTIONAL
Does your child appear too aggressive, timid, too solitary, too dependent or anxious?
Does your child continually whine or cry or show aggression?
Does your child have frequent temper tantrums?
If so, how are they handled?
Does your child have any fears or phobias, ie noise, dark places, spiders or heights?
DISCIPLINE
What kind of discipline is used in your home?
Are you familiar with the ATC method of discipline?
Additional comments
What concerns do you presently have concerning your child?
HISTORY
Is there any family history of learning or developmental disabilities? YES NO

Has your child ever experienced anything traumatic, ie death, separation anxiety, accident,
divorce, etc?
YES NO
Which contagious illnesses has your child had?
List any accidents the child has experienced
List any chronic physical problems and history of hospitalization.
List any disease, serious illness or operations the child has had.
Is your child taking any regular medication? YES NO
Please specify
Does your child, in your opinion, show any signs of visual, auditory, emotional, muscle tone, sensory, hyperactivity,
concentration, co-ordination or speech problems? Please be specific.
Has your child been referred to a specialist? If yes, please specify. YES NO

List any medications (food supplements, modified diets or fluoride supplements currently being administered to the
child?
Has your child ever had ear/hearing examinations or treatment? YES NO
When did this take place?
Who performed the examinations or treatment?
What were the results?
Has your child had grommets inserted?
If so, when were they done?
Are they still in place?
Has the child ever had vision examinations or treatment? YES NO
When did this take place?
Who performed the examinations or treatment?
What were the results?
Is there any food(s) your child should not eat? YES NO
Please specify
Please mark with a “X” what the reason for the above is
Medical reasons Religious reasons Personal reasons
Is your child on a special diet? YES NO If so, what kind?
Is there any other information you would like to share about your child’s eating habits?

DEVELOPMENTAL HISTORY
What kind of birth?
Were there any problems? (Please specify).
Were there any complications after birth? YES NO
Please provide details if yes.
Comment on the health of the mother during pregnancy.
PLAY & SOCIAL EXPERIENCES
Does your child participate in any group experiences YES NO
Where?
Does your child enjoy it? YES NO
Do other playmates visit your child? YES NO
Does your child visit other playmates in their homes? YES NO
How does your child relate to other children?
Does your child prefer to play (please tick relevant block) Alone With other children Both
Does your child have imaginary friends? YES NO
Please explain
Does your child have any pets? YES NO
If so, what animals does he/she have and how many of each?
What are your child’s favourite toys?
What are your child’s favourite activities?
What is your child’s favourite TV program?
How long does your child watch TV each day?

What are your child’s favourite books?
How many times a week does your child read?
EXPECTATIONS
Why did you choose Angels Tutor Centre for your child?
What are your three most important goals for your child in the next 3 year cycle?
1)
2)
3)
In what ways would you like to see your child develop during their time at ATC?
PREVIOUS EDUCATION
Previous school or day care attended (1)
Landline number Mobile number
Duration spent there?
Reason for leaving
Previous school or day care attended (2)
Landline number Mobile number
Duration spent there?
Reason for leaving
HOW DID YOU FIND ANGELS TUTOR CENRE (ATC)?
Website Facebook Friend Referral School E-mail IMPAK Other source
Please provide us with the name if a friend, referral, school or other source helped you find us.

I am committed to enrolling my child from/to
Age 6-9 years Yes No Age 9-12 years Yes No
I declare that to my best knowledge the information given in this document is true and correct.
Signed
Name in print
Date
An application fee of R500 must accompany the Application Form.
EFT and cash payments accepted to:
FNB, Acc name: Mel De Jager (Pty) Ltd, Acc nr: 62 51125 1887 (cheq), Br code: 200410,
Reference: ATCA-YOUR NAME

CONSENT AND INDEMNITY
As a parent, I will acquaint myself with the school rules, regulations and policies and undertake to co-operate
fully with the school authority in enforcing them. I have also acquainted myself with the school layout and
equipment and am satisfied that my child can safely, with the necessary supervision, make use thereof.
In the knowledge that the head teacher, staff, contracted agents and or parents assisting the school shall take all
responsible precautions for the safety and welfare of my child. I hereby indemnify Angels Tutor Centre (Pty) Ltd,
the staff thereof (whether temporary or permanent), contracted agents and or parents assisting the school,
arising from any injury or harm which may be suffered by my child/children.
This indemnity is irrevocable and shall be full of force and effect for the entire duration of my child’s enrolment at
Angels Tutor Centre (Pty) Ltd. The school accepts no responsibility for the insurance of pupils’ possessions.
The principal, head teacher or her nominee is authorized to make any decision, in loco parentis, when specific
authority cannot be reasonably sought in time (providing that such decision is taken in the best interest of the
child). In particular, if in the opinion of the principal, head teacher or the nominee, an emergency has arisen, she
is authorized to take the child to the nearest doctor/medical center/hospital to carry out the necessary treatment
that may be considered necessary.
This application is viewed as an expression of the parents or legal guardians’ trust in this school. As such, it is
requested that recommendations made by the child’s teacher and or Head teacher will be carefully considered
and followed if the child is to remain enrolled. Lack of co-operation of school policies and/or recommendations
will be grounds for terminating the enrolment contract.

I hereby consent, in terms of Sections 45 (1) of the Magistrates Court Act Number 32 of 1944, as amended, in
respect of any proceedings that may be instituted herein, to the jurisdiction of the Magistrates Court.
Furthermore, should the School institute any legal proceedings for the recovery of any amounts outstanding, I
agree to pay all legal costs and charges on the ATTORNEY/ own client scale incurred by the Angels Tutor
Centre (Pty) Ltd.
Upon the signature by the Head teacher/ Principal of Angels Tutor Centre (Pty) Ltd and Parent/ Guardian, a
legal contract is concluded.
Parent/Guardian signature Name in print
Principal: Angels Tutor Centre (Pty) Ltd Name in print
Signed at on this day of (month) of the
year .

LETTER OF UNDERTAKING
Contract of payment
DECLARATION OF PARENT/GUARDIAN
Name of Child
ID number
Full names and ID number of the person responsible for the school account:
In my full capacity of (choose applicable) Father, Mother, Legal Guardian.
Residential address
Postal code
I hereby accept that as my above mentioned child has been offered a place at Angels Tutor Centre (Pty) Ltd,
commencing with the Term of________________________ the following conditions and undertakings will apply
and this will constitute a legal document and forms the basis of a contract between Angels Tutor Centre (Pty)
Ltd and myself. I hold myself responsible for the payment of the full amount of fees charged by Angels Tutor
Centre (Pty) Ltd in respect of the period during which my child is registered as a learner at the school and
understand that the fees are payable on advance.
The Principal is empowered to suspend or remove any learner for adequate cause judged by her in her absolute
discretion that may be considered necessary, in consultation with the involved parents. Should a pupil be
removed from the school by no reason of breach of school rules, the parents shall remain liable for full fees due
for the full calendar month during which the pupil was removed and if such fees were paid in advance, the
school shall not be obliged to refund any portion thereof.

I undertake to pay, using one of the following payment options for the year
1. ANNUAL PAYMENT
The total sum of money for the year payable before the 1st
February__________ is R .
A discount of 3% will be deducted from your account.
Should there be any additional costs to outings, visits etc they shall be paid as necessary.
2. QUARTERLY PAYMENT
Four post dated cheques of R_____________ each dated for the 1st
January, 1st
February, 1st
March etc.
3. MONTHLY PAYMENTS
11 post dated cheques of R________________ each, dated for the 1st
of the month in advance. Should there be
any additional costs they will be paid as necessary.
4. ELECTRONIC PAYMENT
Should you prefer to pay electronically, the banking details are as follows:
FNB, Acc name: Mel De Jager (Pty) Ltd, Acc nr: 62 51125 1887 (cheq), Branch code: 200410
Reference: ATC + NAME OF FIRST CHILD
A reference should be put on the transaction such as your child’s name as proof of payment.
If payments are received after the 4th
of the month R100 will be added to your account.
A full calendar months notice of withdrawal must be given in writing to the school. Any outstanding fees must be
paid in full before the child leaves the school. I hereby consent, in terms of section Magistrate’s Court act
number 32 of 1944, as amended in respect of any proceedings that may be instituted herein, to the jurisdiction of
the Magistrate’s Court. Furthermore, should the school institute legal proceedings for the recovery of any
amounts outstanding. I agree to pay all legal costs and charges to the Attorney/own client scale incurred by
Angels Tutor Centre (Pty) Ltd.

Upon the signature of the Principal of the Angels Tutor Centre (Pty) Ltd and parent/guardian, a legal contract
is concluded.
Parent/ Guardian Name in print
Principal/ Head teacher/ directress Name in print
Signed at on this day of year________

Acceptance of School Rules and Policies
I, parent / guardian of
have read and understand the full content, and accept the rules and policies of Angels Tutor
Centre (Pty) Ltd.
(The rules and policies can be found on our website www.angelstutorcentre.co.za)
Father/ Guardian
Signature
Mother/ Guardian
Signature
Signed at on this day of 20 .
This form must accompany your registration fee and the required admission documents.
For Office Use:
Name of Child
Month, Year of Starting
Grade of starting
Assessed by
Date of Assessment
Accepted Class
Acceptance letter sent

APPLICATION FOR ADMISSION TO ATC

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