Boarding Admission Form

Name ________________________________________ Surname __________________

DOB / / Sex F M
Grade/Form Teacher
Tuition Paid Ref/ Receipt No.
Boarding Fees Paid Ref/ Receipt No.
New Boarder Returning Boarder
Boarder Monthly
Room Allocated
Parent/Guardian Name
Relationship to Learner
Contact Mobile E-mail Address
Address

Approval to Visit or Pick Learner

Name and contacts of approved visiting and picking up parent/guardian.
Name Contact Details
1)
2)
3)
Medical Aid Details
Medical Aid Provider Medical Aid Number
Name of Member Suffix
Medications Handed Over for Administration

Signatures: Bursar ___________________ Signature______________ Date _________

Head ____________________ Signature______________ Date _________
Matron __________________ Signature_______________ Date _________
For Official Use
NB - To Be Handed Over to The Matron or Boarding Staff on Duty for Admission of
Learner.

Page 1 of 1