ENROLLMENT FORM - CRANE INTERNATIONAL ACADEMY

SECTION 1: LEARNER /PERSONAL INFORMATION

ID NUMBER *

NAME *

MIDDLE NAME

SURNAME *

DATE OF BIRTH *

GENDER *

EQUITY *

DISABILITY STATUS *

HOME LANGUAGE *

SECTION 2: LEARNER CONTACT DETAILSYou MUST provide at least one phone number where you can be reached. The address MUST be completed.

TEL NO (WORK)

MOBILE NUMBER *

EMAIL ADDRESS *

ADDRESS *

TOWN/CITY *

LOCAL/DISTRICT MUNICIPALITY *

PROVINCE *

CODE *

SECTION 3: NEXT OF KIN DETAILSYou MUST provide at least one phone number where your next of kin can be reached.

NAME *

SURNAME *

MOBILE NUMBER *

EMAIL ADDRESS

ADDRESS *

TOWN/CITY *

LOCAL/DISTRICT MUNICIPALITY *

PROVINCE *

CODE *

SECTION 4: LEARNER GENERAL DETAILS

HIGHEST SCHOOL QUALIFICATION *0 / 60

NAME OF HIGH SCHOOL ATTENDED *0 / 60

LAST SCHOOL YEAR *

SECTION 4: COURSE DETAILS

CAMPUS

COURSE

UPLOADSAll uploads MUST be recently certified.

ATTACH CERTIFIED ID COPY *

No file chosen

ATTACH CERTIFIED COPIES OF HIGHEST QUALIFICATION

No file chosen

POPI ACT STATUS *

Assisted By (Agent's Name):

CONTRACTUAL DETAILSWhen you register with us, you accept these terms and fees as revised for each relevant year. You also accept our rules (including all regulations, policies and codes of conduct). The person accepting this contract warrants and promises that they have read this contract and understood it, and they have the authority to accept and be contractually bound by the terms of this contract.

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