Application for admission 2027 — Bushwillow Kids Preschool

1

Learner details

Please fill in personal information as it appears on the learner’s birth certificate.

Full names *

Surname *

Initials *

Preferred name *

Date of birth *

Nationality *

ID number

Reason for no ID (if no ID number)

Gender *

Male Female

Dexterity

Right-handed Left-handed Not yet known

Population group * for Department of Education statistics only

Religion

Home language *

Preferred language

The learner lives with *

Learner’s residential address *

2

Family & emergency contacts

Brothers / sisters at Bushwillow (names and classes)

Previous crèche, playgroup or day-care

Years attended

Emergency contact someone other than the parents

Full name *

Relationship to learner *

Mobile number *

Persons authorised to collect the learner

Names and ID numbers

3

Extra-curricular activities & aftercare

Tick any activities you are interested in. This is an indication of interest only, not a formal registration. The school will use the responses to decide which activities to offer, and will send a formal offer — including times and costs — for activities with sufficient interest.

Other (please specify)

4

Learner medical information

Family doctor

Doctor’s telephone number

Clinic / hospital preferred

Medical cover *

Private (no medical aid) Medical aid Hospital plan

Medical aid name

Medical aid number

Main member

Chronic conditions *

Allergies * food, medication, insects, other

Medication taken regularly * name, dose and times

Immunisations up to date * Road to Health booklet

Yes No

Toilet trained

Yes No In progress

5

Admission details

Admission year

Admission term

Pre-primary education so far

None (home) Day-care / crèche Playgroup Other preschool

The learner has special educational, developmental or therapy needs (give details below).

Details of special needs, therapies or assessments

I consent to the use of the learner’s photograph in school newsletters, social media and other publicity.

Anything else we should know about your child interests, routines, strengths

6

Tuition option

Fees for 2027 as set out in the Bushwillow Kids fee structure. The registration fee of R500 is once-off and required. Breakfast is included in school fees.

Monthly tuition *

Half Day — 07:30 to 12:00 · R2,650 per month Half Day + Aftercare — 07:30 to 15:00 · R2,850 per month

Lunch option — served at 12:30 · R200 per month

Banking details and the signed debit-order mandate are completed on the downloadable application form, which you email to the school. We do not collect bank account numbers through this website.

7

Family details

Family status

Both parents Single parent Divorced / separated Guardian Foster care

Parents deceased

Eldest or only child

8

Parent / guardian 1

Guardian type *

Full names *

Surname *

Title

Preferred name

ID / passport number *

Nationality

Date of birth

Gender

Male Female

Mobile number *

Email address *

Home telephone

Work telephone

Home language

Correspondence language

Marital status

Preferred communication

Occupation and employer

Parent / guardian 1 lives with the learner

Parent / guardian 1 receives communication about the learner

9

Parent / guardian 2

Leave blank if there is no second parent or guardian.

Full names

Surname

ID / passport number

Nationality

Mobile number

Email address

Date of birth

Gender

Male Female

Home language

Correspondence language

Marital status

Occupation and employer

Physical address

Parent / guardian 2 receives communication about the learner

10

Accountable person

The accountable person is responsible for payment of all school fees and charges.

Accountable person *

Parent / guardian 1 Parent / guardian 2 Both jointly Other

Full name (if other)

ID number (if other)

Relationship to learner

Mobile number (if other)

Email (if other)

Banking details

Used for the monthly debit order in section 11. If you would rather not enter these online, complete them on the PDF form and email it to the school.

Bank name *

Branch name

Branch code *

Account type *

Cheque / current Savings Transmission

Account number *

Account holder *

11

Debit order authorisation

I hereby authorise Bushwillow Kids Preschool (or its appointed bankers) to recover the following payments for the learner named in this application by debit order from my bank account, as given in the banking details in section 10, on the 1st day of each month.

Payments to be collected (tick all that apply)

Preschool fees 2027, payable over 12 months: Half Day (07:30–12:00) — R2,650 per month Preschool fees 2027, payable over 12 months: Half Day + Aftercare (07:30–15:00) — R2,850 per month Lunch option — R200 per month Registration / enrolment fee (once-off) — R500

Conditions

If a debit order payment is returned unpaid, a double payment may be collected the following month, together with any bank charges for the returned payment.
If a debit order is returned unpaid for a second time, it will not be presented again, and I remain liable for the full outstanding school fees and any costs of recovery.
This authority may be cancelled by giving the school 30 days’ written notice. Cancelling it does not cancel my obligation to pay, and I am not entitled to a refund of amounts withdrawn while this authority was in force, to the extent that those amounts were legally owed to the school.
The party authorised to make withdrawals may not transfer or cede any of its rights to a third party without my written consent, and I may not delegate any of my obligations under this agreement to a third party without the written consent of the authorised party.

Full name of signatory *

Signed at (place) *

Date *

Electronic consent: by ticking this box I provide my electronic consent and signature to this debit order, with the same effect as a handwritten signature. *

12

Documents

Email certified copies (or clear scans) of the following to info@bushwillowkids.co.za after you submit this form. Applications without required documents cannot be finalised.

Learner’s birth certificate (unabridged) *
Learner’s ID document or passport (if issued)
Road to Health booklet / immunisation record *
Latest progress report from previous crèche or preschool (if applicable)
Study permit for non-resident learners
ID document of parent / guardian 1 *
ID document of parent / guardian 2
Medical aid card (if applicable)
Proof of residence not older than 3 months
Court order / guardianship documents (where applicable)

13

Consent & declaration

Permission and consent

I, the parent / guardian of the learner named in this application, confirm that:

My child may take part in all learning, play-based, outdoor, nature and cultural activities organised by the school, including developmental screening by the school’s staff or support team to identify and support any learning needs.
My child may be transported for school outings in vehicles approved by the school management, driven by staff or parents holding valid driver’s licences. I will be informed of outings in advance.
I accept that all reasonable precautions will be taken for my child’s safety and wellbeing, and that I am responsible for medical and / or hospital costs in the event of an injury that is not caused by the gross negligence of the school’s staff.
In an emergency, where I cannot be reached, I authorise the Principal or her representative to obtain medical or surgical treatment for my child.
All medical information supplied in this form is accurate and complete and may be used in an emergency.
I will inform the school promptly if any of the information in this form changes.
I will support my child in following the school’s code of conduct and policies of Bushwillow Kids Preschool.
Personal information in this form will be processed by the school for admission, administration, safety and fee-collection purposes only, in line with the Protection of Personal Information Act (POPIA), and will not be shared with third parties except where required by law.

Indemnity

I / we, the parent(s) or guardian of the learner named in this application, indemnify Bushwillow Kids Preschool, its owners and trustees, and any person employed by or acting on behalf of the school, against any losses, claims, injury or death that may be caused to the learner through his or her use of the facilities provided by the school, except where such loss, injury or death results from the gross negligence or wilful misconduct of the school or its staff.

Declaration by parent / guardian

I, the undersigned parent / guardian, declare that the information supplied in this form is true and correct, and by my signature I authorise the Principal or her representative to verify any of the details supplied. I understand that if any information is found to be untrue, the application may be cancelled and I may be liable for a criminal offence. I understand that submitting this form does not guarantee a place and that admission is subject to space and the school’s admission policy.

I agree to the permission and consent above. *

I accept the indemnity above. *

I make the declaration above, and I give my electronic consent and signature to this application, with the same effect as a handwritten signature. *

Full name of signatory *

Signed at (place) *

Date *

Application for admission

How to complete this form

Learner details

Family & emergency contacts

Emergency contact someone other than the parents

Persons authorised to collect the learner

Extra-curricular activities & aftercare

Learner medical information

Admission details

Tuition option

Family details

Parent / guardian 1

Parent / guardian 2

Accountable person

Banking details

Debit order authorisation

Conditions

Documents

Consent & declaration

Permission and consent

Indemnity

Declaration by parent / guardian

Download, print and email the form.