St Mary's Primary School

p.o box 16031 batho blomfontein 9323 telEFAX:(051) 4322907

Email. stmaryps@mweb.co.za

 PUPIL'S DETAILS

SURNAME :....................................................................................................

FIRST NAMES : .............................................................................................

DATE OF BIRTH : YEAR ............... MONTH ................ DAY .....

 HOME ADDRESS : .........................................................................

                                .........................................................................

                                CODE : .......................

 HOME TEL : ....................... WORK :...................... CELL :...............

 GRADE YOU WISH TO APPLY FOR (IN THE YEAR 2002) .......................

 NAME OF PREVIOUS SCHOOL: ...................................................................

 TEL.No. OF YOUR PREVIOUS SCHOOL : . ................................

________________________________________________________________

FOR THE MEDICAL DOCTOR

has the child got any disease that we at St. Mary's need to know of ? (e.g epilepsy )

YES / NO

Any other health problem ? ..............................................................

SIGNATURE OF DOCTOR ..........................................................

________________________________________________________________

PARENTS / GUARDIANS' DETAILS

NAMES : FATHER ..........................................................................................

: MOTHER ........................................................................................

:GUARDAN ......................................................................................

 SURNAME : (If not the same as child ) .............................................................

 OCCUPATION : FATHER :.................................................................................

MOTHER :...............................................................................

 SIGNATURE OF PARENT : ................................................................................

 RELIGION : ............................................ PARISH/ CHURCH ..........................

 

NAME OF PRIEST / MINISTER ........................