Fax Number: 086 617 7088                   Telephone: (021) 556 8650
                                Cell Number: 076 375 4941           E-mail:

       EDUCARE                               Website:
                                  DETAILS OF THE CHILD APPLIED FOR:
Names In Full                                           Surname
Preferred Name                                          Date Of Birth
Street Address                                          Area                                                       Code
Gender                                                  Language
Weight                                                  Length
Denomination                    Number of children in family                                  Ranking in family
Half-day or Full-day?                            Date Of Admission
Name of previous school / play group/ day mother:

In case of an emergency, when you may not be available, kindly provide us with the names of alternative persons
whom we may contact:
  1.                                                                    Contact Number
  2.                                                                    Contact Number
                                MEDICAL INFORMATION (Specify where applicable)
Previous serious illnesses
Previous operations
Any speech, hearing or sight impediments?
Any allergies?                                                 Mental or psychological defects?
Have all inoculations as prescribed by law been administered?
Is the child's physical development, in your opinion, normal for his /her age?
Name Of Family Doctor                                                       Contact Number
                                        DETAILS OF PARENTS / LEGAL GUARDIAN
Names in Full                                                           Surname
Preferred Name                                                          ID Number
Contact No. (H)                                     Cellular No.                             E-mail
Occupation                                          Company                                  Business No.
Business Address

Language                         Denomination                               Divorced / Separated (If applicable)
Any other remarks

Names in Full                                                               Surname
Preferred Name                                                              ID Number
Contact No. (H)                                     Cellular No.                             E-mail
Occupation                                          Company                                  Business No.
Business Address

Language                         Denomination                               Divorced / Separated (If applicable)
Any other remarks

PARENT / LEGAL GUARDIAN TO INITIAL HERE:_____________________________                                      Page 1 of 5
                                      TERMS & CONDITIONS
          By signing this document, you accept the terms and conditions of LittleGems Daycare when your child is
          accepted into LittleGems daycare.

     1.   Administration & Fees For 2011:
           Registration – R450; Full Day – R1 200; Half Day – R950; After Care (School Children) – R700
             Banking Details:
             S.C. Coetzee
             Cheque Account
             Account No: 1207021822
             Branch Code: 12070
           Fees are payable in advance before or on the first school day of each month.
           Fees for December and January are full payments.
           If fees are not paid by the 3rd of the month, your child will unfortunately not be able to attend school and you
             are still liable for that month’s fee.
           A full months’ fees are payable even if your child leaves during the course of the month.
           A fee of R50 per ½ hour will be charged for late collection of children.
           Special activities and outings will not be compulsory, but will be over and above the normal rate. Fees are
             payable in advance.
           Parents are liable for fees whether or not your child has attended the full month’s quota of days.
             Unfortunately there will be no rebate for missed days.
           A calendar months written notice is required should you wish to withdraw your child from LittleGems Daycare.

     2.   School Times & Holidays:
          Full day: 06h30 – 18h00 (Monday to Friday)
          Half day: 06h30 – 13h00 (Monday to Friday)
          After Care: After School – 18h00 (Monday to Friday)
          We are closed public Holidays and from the 15 December 2011 until 9 January 2012.

     3.   Illnesses & Injuries:
          a) Please attempt to make alternate arrangements for children with a bad cough, sore throat, vomiting, loose
               stomach, high temperature, fever, chickenpox, measles, mumps, diarrhoea, jaundice, etc. This is for your own
               child’s well being as well as for the others. Please notify us when your child is sick and will not attend school.
          b) When we notice a child becoming ill, we observe and take temperature readings. After an hour we phone the
               parent for permission to treat and to advise on whether the child should be taken to the doctor.
          c) Minor injuries, such as small wounds are cleaned, bandaged and recorded in child’s message book for parent’s
          d) In the unlikely event of a serious injury, it is treated and parents are informed immediately. (For extreme
               emergencies, the paramedics/ambulance are called and parents notified straight after)

     4.   Collection of child:
          We will NOT allow your child to leave our school if you have not given us written permission or called the school
          and informed the principal or teacher.

     5.   Personal Items:
          Please mark all clothing, bedding and bags clearly with your child’s name. We do not take any responsibility for any
          theft or loss of, or damage or destruction to any property of whatever nature. We do not except any liability for
          lost or stolen personal items. To avoid any possible fighting, we request that no toys be brought to school.

PARENT / LEGAL GUARDIAN TO INITIAL HERE:_____________________________                              Page 2 of 5
     6.   Food:
          All the food for the day, except the morning snack, is provided by us. Our meals are Nutritional and healthy. We
          like to try different foods. The menu is displayed at the entrance and if your child has any allergies to any food
          type, please send a meal of your choice to school on that particular day.

     7.   Discipline:
          Should there be disagreements, we try to diffuse the situation and encourage the children to apologise to each
          other. We do not use physical discipline. We use the time out/naughty corner method of discipline.

     8.   Website:
          We update our website regularly and add new fun and amusing photos of the children during their activities.
          Should you wish not to have your child on the website, please inform us.

     9.   Shuttle Service:
          There is a shuttle service available to collect and drop your child off in the morning and evenings at an additional

     10. Copies of documents that need to be provided:
         It is the parents duty to change their contact details in writing should it change.
         Copy of child / children’s birth certificate / ID document Immunization card / Clinic card / Copy of both parents /
         guardians ID document


          I am the legal parent/guardian of the child/children that I am enrolling in to LittleGems Daycare. I have read and
          understand the policies and procedures of the school and agree to abide by them and that may be adopted from time to
          time by the school.

          The school reserves its rights to terminate the enrolment contract, should it be deemed necessary. I hereby assume
          absolute responsibility for the payments of fees as a result of the child attending LittleGems Daycare and acknowledge
          that it is payable in advance by the 1 of each month. I/we further agree to be liable for collection commission in the
          amount of 6% of the outstanding amount should further action be instituted against me.

          I hereby agree in terms of Section 45 of the Magistrate’s Court Act No.32 of 1944 that the school shall, at its option, be
          entitled to institute any legal proceedings for the recovery of any monies owing by me to the school in any Magistrate’s
          Court having jurisdiction in respect of such proceedings in terms of Section 28 of the Act. In the event of the school
          having to institute action to recover fees, I understand that I shall be liable to make payment of all costs incurred by the
          school, as between attorney and client.

          I undertake to give ONE calendar months notice (in writing) to the owner. If such notice is not given, a full month’s fees
          shall be paid in lieu of such written notice. I shall advise the school in writing of any changes to my personal details. All
          information given is true and correct and done to the best of my ability.

          The child/children are left in our care at the parent’s own risk, we cannot be held liable for any injury or damage incurred
          on the premises.

           Thus done and signed at ____________________________ on this day ______ of _____________________2011.

            ___________________________                                 ____________________________

                     Mother/Guardian                                            Father/Guardian

            Name: _____________________                                 Name: ______________________

             ID: ________________________                               ID:_________________________

             Principle / Owner: _____________________________

PARENT / LEGAL GUARDIAN TO INITIAL HERE:_____________________________                                   Page 3 of 5
                                          PAYMENT OF FEES
Person responsible for the payment of fees

Contact Number                                                          E-mail
Postal or street address where all correspondence, documents and/or notices relating to this document may be
forwarded to, by post, or delivered.

I do hereby undertake to abide by the rules and regulations, and to endorse fully the principles and the objectives of
the school.

Signed at ____________________________________ on this day _____________ of _____________________2011.

Name: ________________________________


The original completed application has to be presented to the principal with all relevant documents in
order to secure your place in the school.

PARENT / LEGAL GUARDIAN TO INITIAL HERE:_____________________________                      Page 4 of 5
                                        PICK-UP PERMISSION
                                   CHILD PICK-UP / COLLECTION PERMISSION FORM
Full First Name(s) of pupil(s) and Surname

I __________________ the father / mother / guardian of above child give permission that the following person(s)
below can collect my child at LittleGems when I am not able:

Signed: ___________________________                                       Date: _________________________

                   Name                                         Relationship                                ID Number

                                INDEMNITY DECLARATION
I / We, the father / mother / guardian ___________________________ of ______________________ (child), hereby agree that my
child may be taken on excursions and that while the persons in charge of the group and those helping with the transport, will care
for the children to the best of their ability. Neither they, nor any other persons connected to the group, will accept any liability for
any claims arising from any accident or injury happening to the child while he / she is in the care of the group supervisor and to
waive and abandon any claim which may at any time arise as aforesaid, both in my personal capacity and in my capacity as parent
or as guardian of the child. I expressly indemnify the supervisor or such person against any such claim which may arise or be

I / we agree that this indemnity shall commence on the day of signature hereof and shall remain in force and be of effect for the
duration of the pupil’s enrolment with the service provided by LittleGems Daycare.

Signed at ____________________________________ on this day _____________ of _____________________2011.

Mother / Guardian: ________________________________                 Father / Guardian: ________________________________

Principle / Owner:__________________________

PARENT / LEGAL GUARDIAN TO INITIAL HERE:_____________________________                                    Page 5 of 5

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