Application Form - Parktown Boys` High School

PARKTOWN BOYS’ HIGH SCHOOL
REGISTRATION NUMBER: 909086JE DISTRICT: D9
APPLICATION FOR ENROLMENT
ARISE
Telephone: 011 642-4531/2
Fax: 011 642-9212
Website: www.parktownboys.com
Wellington Road
Parktown
Private Bag X15
Parkview
2122
MISSION STATEMENT:
To be an outstanding boys’ school, educating for life through the development of character and potential.
CORE VALUES:
We believe in:
l
l
l
l
l
l
l
l
Commitment to the school’s ethos of excellence and quality
Honesty, integrity and gentlemanly conduct
Tolerance and empathy, trust and respect
Self-discipline, initiative and enterprise
Leadership and team spirit
Full participation
Personal and social achievement
Free communication
These are the collective principles that guide the thoughts and actions of the Parktown Boys’ High School team. The motto of
Parktown Boys’ High School, “ARISE”, inspires the tradition, values and spirit of the learners, parents and staff of the Parktonian
family.
With the above in mind I hereby make application for the learner listed below to attend Parktown Boys’ High School.
PLEASE NOTE THAT INCOMPLETE APPLICATIONS CANNOT BE PROCESSED.
LEARNER INFORMATION:
SURNAME: FIRST NAME: YEAR OF ENROLMENT: BOARDING Yes
ENROLMENT TO GRADE: No
If “Yes” kindly complete attached boarding application form.
DATE OF BIRTH: (Certified copy of birth certificate to be attached)
I.D. NUMBER: HOME LANGUAGE: RELIGION (Not compulsory): MEDICAL AID DETAILS:
MEDICAL AID NAME: MEDICAL AID NUMBER: MAIN MEMBER OF MEDICAL AID: NAME AND TELEPHONE NUMBER OF FAMILY DOCTOR:
LEARNER RESIDES WITH:
BOTH PARENTS MOTHER
FATHER
GUARDIAN
NAMES OF BROTHERS CURRENTLY OR PREVIOUSLY ENROLLED AT PARKTOWN:
NUMBER OF SIBLINGS IN FAMILY:
Page 1
ACADEMIC INFORMATION:
GRADE 8 AND 9:
CHOOSE EITHER AFRIKAANS OR ZULU AS A SECOND LANGUAGE: GRADE 10 - 12:
CHOOSE BETWEEN AFRIKAANS OR ZULU AS A SECOND LANGUAGE.
CHOOSE BETWEEN MATHEMATICS OR MATHEMATICAL LITERACY.
CHOOSE AN ADDITIONAL THREE SUBJECTS FOR YOUR OPTIONAL SUBJECTS (PLEASE REFER TO GENERAL
INFORMATION ATTACHED).
ENGLISH
AFRIKAANS
or ZULU
LIFE ORIENTATION
MATHEMATICS
or MATHEMATICAL LITERACY
ACCOUNTANCY
PHYSICAL SCIENCE
GEOGRAPHY
INFORMATION TECHNOLOGY
BUSINESS STUDIES
LIFE SCIENCE
HISTORY
ADVANCED PROGRAMMED
MATHEMATICS
DESIGN ART - DESIGN
COMPUTER APPLICATION TECHNOLOGY
3
ART - VISUAL
3
GENERAL INFORMATION:
HEALTH ISSUES OF WHICH WE SHOULD BE AWARE: PREVIOUS SCHOOL ATTENDED: TELEPHONE NO.: SPORT AND/OR CULTURAL ACHIEVEMENTS: OTHER ACHIEVEMENTS:
LEADERSHIP POSITIONS: IF IMMIGRANT: COUNTRY OF ORIGIN AND DATE OF ARRIVAL IN SOUTH AFRICA: (RELEVANT HOME AFFAIRS
DOCUMENTS MUST BE ATTACHED)
FAMILY AND PARENTS’ INFORMATION:
NATURAL FATHER
Mr
Dr
Prof
SURNAME:
I.D. NUMBER:
FIRST NAMES:
RESIDENTIAL ADDRESS:
WORK ADDRESS:
POSTAL ADDRESS:
OCCUPATION:
JOB TITLE:
EMPLOYER:
YEARS WITH CURRENT EMPLOYER:
TELEPHONE NO. (WORK):
TELEPHONE NO. (HOME):
CELL:
NATURAL MOTHER
E-MAIL:
Ms
Miss Mrs
Dr
Prof
SURNAME:
I.D. NUMBER:
FIRST NAMES:
RESIDENTIAL ADDRESS:
WORK ADDRESS:
POSTAL ADDRESS:
OCCUPATION:
JOB TITLE:
EMPLOYER:
YEARS WITH CURRENT EMPLOYER:
TELEPHONE NO. (WORK):
CELL:
E-MAIL:
TELEPHONE NO. (HOME):
Page 2
ANY OTHER PARENT / GUARDIAN
(PLEASE SPECIFY)
SURNAME:
I.D. NUMBER:
FIRST NAMES:
RESIDENTIAL ADDRESS:
WORK ADDRESS:
POSTAL ADDRESS:
OCCUPATION:
JOB TITLE:
EMPLOYER:
YEARS WITH CURRENT EMPLOYER:
TELEPHONE NO. (WORK):
CELL:
TELEPHONE NO. (HOME):
E-MAIL:
PAYMENT OF FEES
PLEASE NOTE: IN ACCORDANCE WITH SECTIONS 39 AND 40 OF THE SOUTH AFRICAN SCHOOLS ACT
OF 1996, PARKTOWN BOYS’ IS A FEE PAYING SCHOOL AND FEES ARE COMPULSORY.
PLEASE INDICATE YOUR CHOICE OF PAYMENT METHOD BY TICKING THE APPROPRIATE BLOCK.
PAY IN FULL BEFORE 31 DECEMBER OF THE YEAR PRIOR TO INTAKE (DISCOUNTED AMOUNT)
PAY MONTHLY BY DEBIT ORDER OVER TEN MONTHS (BEGINNING JANUARY THROUGH TO BEGINNING OF OCTOBER)
BANKING DETAILS FOR DIRECT DEPOSITS:
SCHOOL FEES:BOARDING FEES:
Parktown Boys’ High School
Parktonian Foundation
First National BankNedbank
Branch: ParktownBranch: Business Central
Branch Code: 250455Branch Code: 128405
Account Number: 62327887256
Account Number: 128 403 5220
I HEREBY ACKNOWLEDGE THAT ALL THE ABOVE INFORMATION IS CORRECT AND I UNDERTAKE TO PAY SHOOL
FEES AS INDICATED ABOVE.
SIGNATURE:
NAME:
Page 3
REASONS FOR WISHING TO ATTEND PARKTOWN BOYS’ HIGH SCHOOL:
(TO BE COMPLETED IN LEARNER’S OWN WORDS AND HANDWRITING)
TO BE COMPLETED BY THE LEGAL GUARDIAN:
I, 1.
Hereby give permission for
to participate in the normal academic, sporting and cultural activities of the school. I accept that no claim
can be made against the school for injuries or articles of clothing and equipment that may be lost or damaged.
2.
I undertake to make all necessary transport arrangements for school and extra-mural participation.
3.
I will support the school policy with regard to compulsory attendance at school and extra-mural activities,
including weekends, and will not ask for permission to extend vacations or make doctor’s, dentist’s or driving licence appointments during normal school hours.
4.
I accept that if this application is successful it will be in terms of the general conditions governing admissions
and the school’s code of conduct.
SIGNATURE OF PARENT/GUARDIAN:
NAME:
FOR OFFICIAL USE ONLY:
WAIT LIST NUMBER: STATUS OF ADMISSION: APPROVED / NOT APPROVED
REASON IF NOT APPROVED: SIGNATURE: DATE: REPORT INCLUDED: YES / NO
BIRTH CERTIFICATE INCLUDED: YES / NO
IDENTITY PHOTOGRAPH INCLUDED: YES / NO
Page 4
DRUCE HALL BOARDING ESTABLISHMENT
Parktown Boys’ High School
Wellington Road
Parktown 2193
(011) 484 6618
info@surgite.co.za
Application and Agreement for Admission to Druce Hall Boarding Establishment
A. Application is made for admission to Druce Hall as follows:
1. The Parties to this application are:
1.1____________________________________________________________(“Parent/Legal Guardian”);
With identity number ____________________________and contact number___________________
(A copy of the Parent/Legal Guardian’s Identity Document must accompany the Application Form)
1.2 of _____________________________(“Learner’) with identity number
______________________________
his preferred name being ___________________________; and
1.3 Druce Hall (“Druce Hall”) a private Boarding Establishment.
2. Application is made by the Parent/Legal Guardian for the Learner to be admitted to Druce Hall from the
beginning of Term ___________of 20_______in Grade ________ until completion of his matric year unless
residence is terminated in terms of this application.
3. Within 14 (fourteen) days upon acceptance of this application, a special levy of R1500.00 (one thousand
five hundred rand) is payable into the following bank account:
Name
:
The Parktonian Foundation Hostel
Bank
:
Nedbank
Account Number :
1284035220
Branch Code
:
128405
Account Type
:
Current
Reference
:
surname/grade
B. Upon acceptance of the application, the Parties agree to the terms and conditions as
incorporated as follows:
4. The Parent/Legal Guardian must pay Hostel fees as determined by the Hostel, which must be up-to-date
on the 1st day of each term when the Learner commences residence in Druce Hall for that specific term.
5. The special levy payable per clause 3 and the Hostel fees payable per clause 4 exclude the cost of outings
and events, medical expenses and/or other services offered by Druce Hall or the School to the Learner.
6. Should there be a financial inability to pay the Hostel fees, the Parent/Legal Guardian will without delay
notify the Hostel of same in order to agree to an alternative arrangement, if any. The same notification
must be provided to the Hostel upon the Parent/Legal Guardian applying for sequestration or debt review.
7. Should the Parent/Legal Guardian fail to make payment of the Hostel fees on the due date/s as agreed,
the Hostel shall demand payment of the outstanding amount. Should it receive the outstanding amount
within 7 (seven) days after demanding payment, it will allow the Learner to remain at Druce Hall failing
which the residence of the Learner will terminate with immediate effect.
8. The Parent/Legal Guardian give the Hostel permission to request credit/criminal checks, from an
authorised/registered body on his/her behalf.
9. The Parent/Legal Guardian may terminate the Learner’s residence on 1 (one) calendar months’ notice.
S/he will be entitled to a refund of the Hostel fees paid for the period extending beyond the termination date.
10.If no notice of termination is provided per clause 9 and the Learner is removed from residence, the
Parent/Legal Guardian shall be liable for 1 (one) month’s payment of Hostel fees in lieu of a deemed
notice of termination.
11.While the Learner is in residence, control and discipline of the Learner will be exercised in accordance with the School’s policies and procedures. Druce Hall agrees to protect the Learner and act in his best
interests.
12.The Parent/Legal Guardian allows the School and/or Druce Hall to consent on his/her behalf to any
emergency operation or medical treatment required by the Learner, without prior consent being
obtained from the Parent/Legal Guardian.
13.The Learner’s medical aid details are:
Medical Aid
:
__________________________________________
Medical Aid number
:
__________________________________________
Doctor’s name
:
__________________________________________
Doctor’s contact number :
__________________________________________
14.An alternative or next of kin name and contact number is:
________________________________________________________________________
15.All legal documents, notices or other communications must be delivered to the following address of the Parent/Guardian, which will act as its domicilium citandi et executandi:
16.All legal documents, notices or other communications must be delivered to the following address, for the attention of Druce Hall, which will act at its domicilium citandi et executandi:
Parktown Boys’ High School, Wellington Ave, Parktown
17.Non-legal documents, notices or other communication between the Parties may be by electronic
communication where a “read receipt” must be attached to each electronic communication sent so it can be
determined that the electronic communication was received and read by the other Party.
18.The School and Druce Hall are indemnified against loss or damage caused to the Learner resulting from
their fault (negligence or intent) during the Learner’s time of residence.
19.This agreement constitutes the whole agreement between the Parties and it may only be amended if the
Parties agree to the amendment in writing, sign it and attach it as an Annexure.
20.This application is additional to any other application/agreement entered into by the Parent/Legal
Guardian and the School and/or Druce Hall.
21.No Party shall be bound by any express or implied term, representation, warranty, promise, or the like
not recorded in this agreement.
22.Signed at ____________________on______day of_____________________20_____
__________________________________________
Parent/Legal GuardianWitness
Contact Details of Parent/Legal Guardian:
Name of Parent/Legal Guardian:
__________________________________________
Email address:__________________________________________
Mobile Number:__________________________________________
Landline Number:__________________________________________
Fax:
4461
Fax:086
086613
613
4461
Website:
Website:www.parktownboys.com
www.parktownboys.com
ARISE
(To be completed by the Principal of the learner’s present school and returned to Parktown Boys’
High School by the
the parent
parent // guardian.)
guardian.)
ARISE
PARKTOWN BOYS’ HIGH SCHOOL
Dear Parents/Guardian
Thank you for your application. Please take note of the following instructions and
information:
PROCEDURE TO BE FOLLOWED WHEN COMPLETING ENROLMENT DOCUMENT
1. Application forms which are incomplete or which are submitted without ALL
required supporting documentation will not be considered for enrolment.
2.
Please attach to the Enrolment Application:
• Oneidentityphotograph
• Acopy of the latest school report
• Acopyofhisbirthcertificate
• Wherepossiblepleasealsorequestatestimonialfromcurrent
school attended (Testimonial document attached)
• Acopyofbothparents’/guardians’I.D.documents
• ProofofResidence(Utility/Ratesbill)
• ProofofEmployment
3. EachapplicantwillbeallocatedapositiononeitherWaitlistAorB dependantonSchoolGoverningBodyandGautengDepartmentof
Education criteria.
4. Youwillbeadvisedinwritingastowhetheryourchild’sapplicationhasbeen
successful or not.
5. Onreceivingnotificationofprovisionalacceptance,anon-refundable
depositofR5500.00mustbemadetotheschoolbursar.Thisdeposit
includesanamountofR3500.00whichwillbedeductedfromtheschool fees the following year.
6. Onthefirstdayofschool,thelearnermustproducehistransfercardand
most recent school report. These must be handed to the form tutor.
Our address and contact numbers:
ParktownBoys’HighSchool
WellingtonRoad Parktown
2193
Tel (011)642-4531/2
Fax (011)642-9212
Email: beards@parktownboys.com
PrivateBagX15
Parkview
2122
PARKTOWN BOYS’ HIGH SCHOOL FEES FOR 2015.
2014:
Bankingdetails:
Banking
details:
Schoolfees:R33950.00
Boardingfees:R45636.00
School
fees: R36740.00
Boarding fees: R48950.00
ParktownBoys’HighSchool
ParktonianFoundation
Parkown
Boys’ High School
Parktonian Foundation
FirstNationalBank
Nedbank
First
National Bank
Branch:Parktown
Branch:BusinessCentral
Branch:
Parktown
Branch: Business Central
BranchCode:250455
BranchCode:128405
Branch
Code: 250455 Branch Code: 128405
AccountNumber:62327887256
AccountNumber:1284035220
Account
Number: 6232 7887 256
Account Number: 128 403 5220
Please use your son’s full name as a reference on all EFT and direct deposits.
Website: www.parktownboys.com
Website: www.parktownboys.com
Website: www.parktownboys.com
Website: www.parktownboys.com
Website: www.parktownboys.com
ARISE
•
5Science
Scienceand
andBiology
Life Science
laboratories
Include
laboratories,
a Design and Technology Centre, a Media Centre, an Art
•
2three
Design
and Technology
Centre,
Computer
CentresCentres
and an Indoor Multi-purpose Sports Centre.
•
Media Centre
•
Centre
IncludeArt
Science
and Biology laboratories, a Design and Technology Centre, a Media Centre, an Art
•
3
Computer
Centres
Centre,
three
Computer
Centres
and an Tennis,
Indoor Multi-purpose
Centre.Rugby, Shooting,
Cricket, Rowing, Swimming,
Waterpolo,
Cross Country,Sports
Golf, Hockey,
•
20 fully interactive classrooms
Soccer, Squash and Athletics.
•
180-seater Audio-Visual room
•
3 Glass-back squash courts
Cricket, Rowing, Swimming, Waterpolo, Tennis, Cross Country, Golf, Hockey, Rugby, Shooting,
•
2-lane indoor cricket centre
Soccer, Squash and Athletics.
•
2 fully-equipped gyms
•
Water-based Astro turf
•
Competition standard Water Polo pool
Include
Science
and
Biology laboratories,
a
Design and
Technology Centre,
a
Media Centre,
an Art
Include
Science
and
laboratories,
a
and
Centre,
a
•
Weekly
boarding
establishment
Include
Science
and Biology
Biology
laboratories,
a Design
Design
and Technology
Technology
Centre,
a Media
Media Centre,
Centre, an
an Art
Art
Centre,
three
Computer
Centres
and
an
Indoor
Multi-purpose
Sports
Centre.
Centre,
three
Computer
Centres
and
an
Indoor
Multi-purpose
Sports
Centre.
Centre, three Computer Centres and an Indoor Multi-purpose Sports Centre.
Include Science and Biology laboratories, a Design and Technology Centre, a Media Centre, an Art
Include Science and Biology laboratories, a Design and Technology Centre, a Media Centre, an Art
Centre, three Computer Centres and an Indoor Multi-purpose Sports Centre.
Centre, three Computer Centres and an Indoor Multi-purpose Sports Centre.
Swimming,
Waterpolo,
Cricket,
Rowing,
Water Polo,Tennis,
Tennis,Cross
CrossCountry,
Country,Golf,
Golf,Hockey,
Hockey,Rugby,
Rugby,Shooting,
Shooting,
Cricket,
Rowing,
Swimming,
Waterpolo,
Tennis,
Cross
Country,
Golf,
Hockey,
Rugby,
Shooting,
Cricket,
Rowing,
Swimming,
Waterpolo,
Tennis,
Cross
Country,
Golf,
Hockey,
Rugby,
Shooting,
Soccer,
Squash,and
Athletics
and Football.
Soccer,
Squash
Athletics.
Soccer,
Soccer, Squash
Squash and
and Athletics.
Athletics.
Cricket, Rowing, Swimming, Waterpolo, Tennis, Cross Country, Golf, Hockey, Rugby, Shooting,
Cricket, Rowing, Swimming, Waterpolo, Tennis, Cross Country, Golf, Hockey, Rugby, Shooting,
Soccer, Squash and Athletics.
Soccer, Squash and Athletics.
Brass
and Drum Corps, Chess, Choir, Drama, First Aid, Traditional Dancing, Heart of the Lion,
Media Centre, Oratory, Photography, Stock Exchange Game, Philosophy Society, Scrabble and Art Club.
ACADEMIC INFORMATION:
Criteria: Grade 10 to 12. At least one of the following three subjects must be selected: Geography, Life
Science or Physical Science.
IMMIGRANTS:
All immigrants must be in possession of a Study Permit and the annual school fee is payable in advance.
GOVERNING BODY:
Elected every three years, comprising Parents, Teachers and Learner Representatives. In terms of the
legislation for public schools, it is responsible for staff appointments, maintenance and development of
grounds and buildings, admission requirements, the setting of fees, budgets, control of finance, and liaison with the Headmaster, the District Office and Governing Body Foundation of South Africa, and policy
development. PTO
BOARDING ESTABLISHMENT:
Onoccasion,sportsmenmayapplyforpermissiontospendFridayeveninginDruceHallto
Boardingfeesaretobepaidmonthly,inadvance,totheParktonianFoundation(separateaccount).
THE SCHOOL SHOP:
Uniformandbook-listswillbesuppliedpriortoadmission.Allschoolrequirementsareobtainable
fromourschoolshop.whichissituatedattheschool.Theshopisopenduringschoolhoursaswell
will be supplied
Uniformprior
and book-lists
to admission.
willAll
be school
supplied
requirements
prior to admission.
are obtainable
All school requirements are obtainable
asextendedhoursovertheDecembervacationperiod.Theproprietorscanbecontactedon
will be supplied
Uniformprior
and book-lists
to admission.
willAll
be school
supplied
requirements
prior to admission.
are obtainable
All school requirements are obtainable
011484-2420orthroughtheschoolswitchboard.
will
supplied
Uniform
prior
and book-lists
to
will
All
beschool
school
supplied
requirements
prior to admission.
are obtainable
All school requirements are obtainable
h
thebeschool
011 switchboard.
484-2420
oradmission.
through
the
switchboard.
MENTOR
PROGRAMME:
h the school
011 switchboard.
484-2420
or through the school switchboard.
EverylearnerformspartofaMentorGroupcomprisingarangeofage-groupswhichisfacilitated
byaneducator.Theymeetonaweeklybasistodiscussandexchangelifeskills.
h the school
011 switchboard.
484-2420 or through the school switchboard.
ACADEMIC HOURS:
Monday Tuesday
Wednesday
Thursday
Friday
07h45 - 15h00
07h45 - 15h00
07h45 - 13h30
07h45 - 15h00
07h45 - 15h00
PARKTOWN BOYS’ HIGH SCHOOL
MEDIA PERMISSION FORM
Dear Parent/Guardian,
During the school year, photographs will be taken of the pupils as they participate in various events. These
photographs may be accessed by the staff for inclusion in various media, including newspapers , magazines , and
electronic media such as web page, Facebook and Twitter, in as well as various presentations to parents and other
interested parties.
The photographs may be of groups of pupils or individuals, and the pupil’s names may be used. For pupil protection
online, a pupil’s photograph and last name will not appear together on the school webpage. It is only when photographs
are sent to the newspaper that pupils’ full names will appear.
Please select one option:
I give permission for my child/children’s photograph to be published or used in marketing material.
or
I DO NOT wish my child/children’s photograph to be published or used in marketing material.
Please note that from time to time, photographs of the whole school/large groups/ teams may be used (for example,
sports team photographs). We cannot exclude specific pupils from these group photographs.
_______________________________________
_______________________________
Child’s/Children’s NamesGrade 2015
_____________________________________
________________________________
Parent’s/Guardian’s NameParent’s/Guardian’s Signature
_
____________________________________
Date
PARKTOWN BOYS’ HIGH SCHOOL
Annexure A
SOUTH AFRICAN SCHOOLS ACT, NO 84 OF 1996
REGULATIONS FOR THE EXEMPTION OF PARENTS FROM PAYMENT
OF SCHOOL FEES
CHECK LIST FORM
(Mark with a cross in applicable box)
1. Has the principal informed you about the amount of the annual
School fees to be paid?
YESNO
2. Has the principal informed you that you are liable for the payment
of school fees unless you are totally exempted from paying school
fees.
YES NO
3. Has the principal informed you about your right to apply for
Exemption from paying school fees?
YES NO
4. Do you wish to apply for such an exemption?
YES NO
5. Do you wish to be assisted in making such application?
YES NO
6. Has the principal provided you with the form (Annexure B)
YES NO
for application for exemption?
_________________________
Name of parent
_________________________
Signature of parent
_________________________
Date