Pupil Information Form

Kyalami Estates Pre-Primary - Pupil Information

Kyalami Estates Pre-Primary (hereinafter referred to as “the school”)

CHILD’S INFORMATION:

NAME OF CHILD

DATE OF BIRTH

ID NO

SEX

PHYSICAL ADDRESS

CODE

POSTAL ADDRESS

CODE

WHO DOES THE CHILD LIVE WITH

NATIONALITY OF CHILD

POSITION IN THE FAMILY

BROTHERS NAMES AND AGES

SISTERS NAMES AND AGES

RELATIVES OR OTHER ADULTS IMPORTANT TO YOUR CHILD (Including helpers/au pairs)

PARENT’S INFORMATION:

FATHER’S NAME

DATE OF BIRTH

ID NO

TEL (H):

TEL (W):

TEL (CELL)

EMAIL ADDRESS

CAR REGISTRATION

MOTHER’S NAME

DATE OF BIRTH

ID NO

TEL (H)

TEL (W)

TEL (Cell)

EMAIL ADDRESS

CAR REGISTRATION

MARRIED STATUS

ARE BOTH PARENTS AT HOME?

HAS THERE BEEN

A death in the family?
Divorce?
Seperation?
An unfortunate circumstance?

Please provide details

MEDICAL DETAILS

In order to comply with Municipal Health Regulations and in the event of your child requiring urgent medical attention, parents hereby authorise the school and any of its’ employees to seek the necessary medical assistance necessary for your child when the school is unable to contact the parents or their nominated medical practitioner.

NEXT OF KIN

TEL (H)

TEL (W)

TEL (Cell)

RELATIONSHIP TO CHILD

DOCTORS NAME

DOCTORS TEL NO

DOCTORS CONSULTING ROOMS ADDRESS

MEDICAL AID DETAILS

MEDICAL AID NUMBER

MEDICAL HISTORY

HEADACHES

COMMENTS AND INSTRUCTIONS

FREQUENT COLDS

COMMENTS AND INSTRUCTIONS

EPILEPSY

COMMENTS AND INSTRUCTIONS

HAEMOPHILIA (Bleeder)

COMMENTS AND INSTRUCTIONS

URINARY INFECTIONS

COMMENTS AND INSTRUCTIONS

URINARY INFECTIONS

COMMENTS AND INSTRUCTIONS

ASTHMA

COMMENTS AND INSTRUCTIONS

HAYFEVER

COMMENTS AND INSTRUCTIONS

PENICILIN

COMMENTS AND INSTRUCTIONS

BEE STINGS

COMMENTS AND INSTRUCTIONS

FOOD ALLERGIES

COMMENTS AND INSTRUCTIONS

OTHER

COMMENTS AND INSTRUCTIONS

PHYSICAL CONCERNS AND DEVELOPMENTAL HISTORY

SIGHT

If yes please provide details

SPEECH

If yes please provide details

HEARING

If yes please provide details

PHYSICAL

If yes please provide details

LEARNING DIFFICULTIES

HISTORY OF CHILD

NERVOUS HABITS e.g thumb-sucking, nail-biting, biting lips or picking nose

HOW ARE THESE HABITS TREATED?

OPERATIONS (grommets, tonsillectomy)

GENERAL COMMENTS REGARDING HEALTH

(THIS SECTION IS ONLY FOR ORANGE AND YELLOW CLASS CHILDREN)

BORN PREMATURE

WHEN BOTTLE INTRODUCED

WHEN SOLIDS INTRODUCED

STILL ON BOTTLE

STILL ON DUMMY

AGE WALKED

AGE TALKED

PRESENT STATE OF SPEECH ABILITY

POTTY TRAINED

SLEEP WITH A NAPPY

DAILY ROUTINE (ORANGE CLASS ONLY)

SLEEPING

HOW CHILD SLEEPS

Back
Side
Tummy

USUAL DURATION OF SLEEP

FALLS ASLEEP WITH

Dummy
Bottle
Nothing
Other

Details of other

FEEDING (ALL FOOD NEEDS TO BE BROUGHT FROM HOME)

TIME OF FEED

WHAT IS FED

HOW MUCH IS FED

By checking the "I agree box" hereto, you certify that you are authorised to enter into this agreement and that the above information provided herein is true and correct. You further authorise the school and any of its’ employees on duty to seek medical attention if your child requires it. You further hereby accept and understand the terms and conditions of the school and will take the full responsibility in complying with same.

Please check

I agree

DATE

Security Code