ONLINE APPLICATION FORM

Please complete the following application form, providing as much detail as possible.

The more we know about your child, the better prepared we will be to assist them in the best way possible.

Date of Application

Child's Full Name

Child's ID Number

Please upload a copy of your child's ID/Birth Certificate

Child's Date of Birth

Child's Age

Right or Left Handed

Right Left

Street Address

Complex, Appartment, Suite

City

Country

Child's Home Language

Child's Current School

School's Phone Number

Child's Current Grade

Name of Current Class Teacher

What Are The Child's Living Arrangements?

Name of Child's GP/ Paediatrician

GP/ Paediatrician's Number

Medicle Aid Name and Plan

Medicle Aid Number

Please Upload a Copy (photo/scan) of Medical Aid Card

Are The Child's Vaccinations Up To Date?

Yes No

Please Upload a Copy of Hospital/ Clinic Card

Siblings (Please Include Stepsiblings)
Name

Age

School

Grade

Father's/ Guardians Full Name

Father's/Guardian's ID no

Please Upload a Copy of Father's/Guardian's ID

Father's/Guardian's Marital Status

Street Address

Complex, Apartment,Suite, Etc.

City

State Province

Postal/Zip Code

Country

Work Number

Home Number

Mobile Number

Email Address

Mother's/Guardian's Full Name

Mother's/Guardian's Full Name ID Number

Please Upload a Copy of Mother's/Guardian's ID

Mother's/Guardian's Marital Status

Street Address

Complex, Apartment, Suite, Etc.

City

State/Province

ZIP/Postal Code

Country

Work Number

Home Number

Mobile Number

Email Address

Details of Person Resposible For Paying School Fees
Full Name

Work Number

Home Number

Mobile Number

Email Address

Reason For Applying at Wings Discovery Centre

Please detail any pregnancy and/or birth related problems regarding your child

Did your child reach milestones without any trouble as a baby/toddler i.e. – crawling, walking, eating solids, sleeping patterns, etc.? Please also include the ages when he/she started crawling, walking and eating solid foods below:

Does/did your child suffer from any physical illnesses/allergies or medical or any other conditions which may affect his/her learning experience at school? Please give details below:

Please list any previous assessments by Occupational Therapist / Psychologist / Optometrist / Audiologist / Remedial Therapist / Other professional:

Assessment Carried Out

Dates of Assessment Carried Out

Please upload copies of any reports you have from previous assessments

Describe your child’s attitude towards school and his/her relationship with his/her teachers.

Pre-Primary school(s) / day-care centre(s) attended? Please give name of school and dates attended.

Previous schools attended? What was your child’s experience of school?

In which sports / extra-mural activities does your child participate?

Any Grades repeated at school? Which Grade was repeated and why?

Any emotional traumas or life events suffered in the past? (E.g. divorce, moving, loss, grief, etc.)

What are your child’s strengths and interests? What makes him/her special and unique?

Any other information you feel is relevant?