APPLICATION FORM 2021

Application Form
THE LITTLE BARN ACADEMY
66 BLOMME LANE
GREENBUSHES
PORT ELIZABETH
6390
Name of Child:
Age
Date of Birth:
MonthDayYear
1
Home Phone Number:
Email Address:
example@example.com
Mother Cell Phone:
Father Cell Phone:
Parents' information
Mother's name:
2
Father's name:
3
List other family members attending Little Barn Academy
1.
2.
3.
Medical Consent in Case of Emergency:
In the event of a medical emergency, I would like Little Barn Academy to contact
Doctor's Name:
Address:
If the above named doctor is not availlable Little Barn Academy may take my Child to the nearest hospital. I give permission for said hospital and/or doctor to treat my Child.
Parents will be responsible for all medical costs
In the event of Medical emergency when I cannot be reached, I hereby authorize the administration of any medical procedure deemed necessary by the doctor, or should doctor be unavailable, by any other physician or medical personel.
Medical Facts and History
Communicable Diseases
Other
Allergies:
Medications:
List any ongoing chronic medications that might impact the child's wellbeing while at the preschool
Medical Conditions
Please list any existing medical conditions that may impact the child's health and well-being in the preschool
Limitations to physical activity
Please list any existing medical conditions that may restrict the child's physical activity in the preschool
Special equipment
Please list any orthodontic devices/prosthesis, glasses etc.
Special equipment
Please list any orthodontic devices/prosthesis, glasses etc.
Allergies
Please list any allergies or reactions to any food, animals, pediatric asthma etc. Its very important to mention nut allergies
Special Diets
Any special diet/supplement that are medically prescribed should be included
Behavioral/Mental Health Issues
Please mention any behavioral conditions or mental health diagnoses eg. Autism, ADHD etc.
AUTHORIZATION & RELEASE FOR EPIPENS AND INHALERS
Please tick the correct option
Directions for use
Please indicate dosage, frequency etc of Epipen
I, parent's name, parent/legal guardian of child's name request that the administration of the above noted medication be provided. I understand that the service will be provided by a person with no medical or nursing training. All training will be parent's responsibility. I agree to provide Little Barn Academy with an updated medical statement if there is any change in the physicians instructions with respect to medication. I hereby release Little Barn Academy, its employees and contractors from all manner of actions, causes of actions, lawsuits, damage or injuries, however caused, arising out of the administration or failure to administer medication as provided herein.

Signature Date
PHOTO CONSENT
I hereby give my permission to the staff of Little Barn Academy to photograph my child. I understand that these photographs may be posted in the academy or on Little Barn Academy's website or social media where they may be viewed by individuals other than preschool participants. I acknowledge further that parents of other preschool learners might take pictures of their own children that might include my child.
Date:
MonthDayYear
4
Signature
Clear
AS PARENT/GUARDIAN OF SAID APPLICANT, I DO HEREBY GRANT PERMISSION FOR MY CHILD TO PARTICIPATE IN ALL SCHOOL ACTIVITIES, WHICH FORM PART OF THE DAILY ROUTINE.
I hereby grant permission for my child to use all of the play equipment and participate in all of the activities of the school, and to leave the school premises under the supervision of a staff member for scheduled field trips.
The Little Barn Academyl endeavour to adhere to the highest standard of care while looking after your child. However, The Little Barn Academy cannot be held liable for any injury or loss of any nature suffered, which occurred due to events beyond its reasonable control. The Little Barn Academy cannot be held liable for the actions of third parties not associated with The Little Barn Academy or natural disasters. This indemnity does not include the negligence of The Little Barn Academy, its agents or employees.
Signature of Parent/Guardian
Clear
Departure Consent
I, as legal guardian/Parent hereby authorize the following persons to pick up my Child from the Preschool
Relationship:
Name:
Address:
Home Phone:
Business Phone:
Please note: ID is required to collect kids from school
OUTINGS
OUTINGS TO PLACES OF INTEREST MAY BE UNDERTAKEN DURING THE YEAR. NO CHILD WILL BE ALLOWED TO ACCOMPANY THE GROUP WITHOUT A WRITTEN INDEMNITY SIGNED BY THE LEGAL GUARDIAN.
INTERVIEWS
PARENTS MAY DISCUSS CONCERNS WITH THE SCHOOL. AN APPOINTMENT IS REQUIRED TO ENABLE A DISCUSSION TO BE CONDUCTED UNDISTURBED.
RULES & REGULATIONS
- ON ACCEPTANCE, A FEE OF R250 IS REQUIRED FOR REGISTRATION WHICH IS NON-REFUNDABLE.
- THE SCHOOL FEES ARE PAID IN ADVANCE, FAILURE TO PAY SCHOOL FEES WILL RESULT IN SERVICE BEING TERMINATED FOR YOUR CHILD, NO PAYMENT MEANS NO SERVICE. ONE CALENDAR MONTH’S NOTICE IS REQUIRED SHOULD YOUR CHILD LEAVE THE CENTRE.
- WE DO NOT EXCEPT NOTICES DURING THE MONTH OF SEPTEMBER, OCTOBER,
- NOVEMBER. A FULL MONTH’S FEE IS PAYABLE WHETHER YOUR CHILD ATTEND OR NOT.
- THE SCHOOL OPERATES MONDAY TO THURSDAY FROM 7AM TO 5:30PM AND FRIDAY FROM 7AM TO 5:00 PM. MONDAYS TO THURSDAYS, THE GATE WILL BE LOCKED FROM 8:30 TO 2PM, WITH THE EXCEPTION OF FRIDAYS
- FRIDAYS IT WILL REOPEN AT 1PM, PLEASE ARRANGEMENT WITH YOUR TEACHER IS REQUEST IF THERE IS A NEED TO FETCH YOUR CHILD BEFORE THAT. CHILDREN FETCHED LATER THAN THE INSTRUCTED TIME, SHALL PAY A PENALTY OF R100 FOR EVERY 15MINS PAST CLOSING TIME.
- EACH CHILD SHOULD HAVE AN EXTRA SET OF CLOTHES, IN CASE OF AN ACCIDENT. THE CLOTHES WILL REMAIN AT SCHOOL.
- PARENTS ARE REQUESTED TO CHECK THEIR CHILDREN’S BAGS FOR WET CLOTHING AND NOTES FROM THE TEACHER. MESSAGE BOOKS MUST BE SIGNED AND READ EVERYDAY.
- ALL ITEMS MUST BE CLEARLY MARKED AS THE SCHOOL IS NOT RESPONSIBLE FOR LOST ITEMS.
- EACH CHILD IS REQUIRED TO BRING HIS/HER OWN TOOTHBRUSH AND HAIRBRUSH.
- CHILDREN ARE NOT ALLOWED TO WEAR FANCY EARRINGS, GLOVES, RIBBONS AND JEWELLERY TO SCHOOL AS WE WILL NOT BE HELD RESPONSIBLE FOR LOST ITEMS.
- ALL CHILDREN MUST HAVE A SCHOOL T-SHIRT WHICH MUST BE WORN ONLY FOR OUTINGS OR ON FRIDAYS. THIS IS OBTAINABLE FROM THE PRINCIPAL. THERE WILL BE A WEEKLY HEALTH INSPECTION, EVERY MONDAY. NAILS AND HAIR. BOYS HAIR MUST BE CUT SHORT; GIRLS HAIR MUST BE TIDY AND PLATTED.
- EACH CHILD SHOULD BRING 2 SLICES OF BREAD, JUICE AND FRUIT IS POSSIBLE.
- PARENTS ARE REQUIRED TO PACK A HEALTHY LUNCH BOX AND SHOULD STAY CLEAR OF JUNK FOOD, SWEETS AND BONY MEATS E.G FISH AND LARGE STEAKS.
- PORRIDGE WILL BE SERVED AT 8:30AM, SO ALL CHILDREN MUST BE AT SCHOOL BY 8:00AM.
- THE SCHOOL GATE WILL BE LOCKED AND NO CHILDREN WILL BE ALLOWED AS THIS INTERFERES WITH THE DAILY PROGRAMME.
- IT IS COMPULSARY FOR PARENTS TO ATTEND MEETINGS. FAILURE TO ATTEND A MEETING WITHOUT AN APOLOGY WILL RESULT IN A FINE CHARGED TO THE PARENT'S ACCOUNT AS THE MEETING IS IN THE INTEREST OF YOUR CHILD.
- ALL PARENTS ARE REQUIRED TO PARTICIPATE IN OUR FUNDRAISING EFFORTS. YOUR CO-OPERATION IS GREATLY APPRECIATED.
- ACTIVITY CO-OPERATION WITH PARENTS IS ESSENTIAL
- STRANGES FETCHING CHILDREN IS NOT ALLOWED. PLEASE PHONE IN ADVANCE IF THERE IS A CHANGE OF TRANSPORT OR A NEW PERSON FETCHING YOUR CHILD.
- PLEASE LEAVE A CONTACT NUMBER IN THE EVENT OF AN EMERGENCY. A LANDLINE NUMBER IS PREFERED.
- NO SWEETS, CHIPS, CHOCOLATE ETC. IS ALLOWED DURING THE WEEK. ONLY FRIDAYS
- CHILDREN ARE NOT ALLOWED TO BRING CAKE OR BISCUITS FOR LUNCH TO SCHOOL
- ONLY MARIE BISCUITS AS A SUBSTITUTE FOR BREAD IS ALLOWED
- THE SCHOOL HAS 4 OUTINGs PER YEAR, ONE PER TERM. GRADE R 6 OUTINGS. ALL
- OUTINGS ARE EDUCATIONAL AND COMPULSORY.
- BIRTHDAYS ARE SPECIAL.PARENTS ARE REQUIRED TO SEND A CAKE TO SCHOOL THE FRIDAY OF THE BIRTHDAY WEEK.
- CHILD CAN CELEBRATE WITH HIS/HER CLASS. ALL CHILDREN ARE ALLOWED TO BRING THESE ITEMS WHEN ITS THEIR BIRTHDAY. PLEASE ARRANGE WITH THE TEACHER IN ADVANCE. ONLY BLOCKS OF CAKE IS ALLOWED. NO ROUND CAKE
- CHILDREN MUST WEAR COMFORTABLE CLOTHES TO SCHOOL. NO BELTS AND NO HIGH HEELS. THE SCHOOL SERVE MEALS MON-THU AND PORRIDGE MON-FRI. PARENTS ARE REUIRED TO PACK LUNCH ON FRIDAYS. PLEASE PACK 2 SLICES OF BREAD, A YOGHURT, A JUICE AND A FRUIT EVERYDAY. SWEETS ONLY ON FRIDAYS
I hereby confirm that I have read and understood the rules and regulations of the school and will adhere to these rules at all times.
Print name
Signature
Clear
Legal Guardian/Parent
Witness
2020 SCHOOL FEES PAYMENT PLAN
Jan 1300
Feb 1300
Mar 1300
Apr 1300
May 1300
Jun 1300
Jul 1300
Aug 1300
Sep 1300
Oct 1300
Nov 1300
Dec 750
Total amount payable for the year = R15050
School fees only
Payment due dates on the last day of each month, payable in advance.
I, the parent hereby understands how the payment plan works and commit to adhere to our agreement of payment as stipulated above.
Parent/Gaurdian responsible for school fees:
Signature
Clear
Date
MonthDayYear
5
Should be Empty:

Parents' information

Medical Consent in Case of Emergency:

Medical Facts and History

AUTHORIZATION & RELEASE FOR EPIPENS AND INHALERS

PHOTO CONSENT

Departure Consent

OUTINGS

INTERVIEWS

RULES & REGULATIONS

2020 SCHOOL FEES PAYMENT PLAN

Total amount payable for the year = R15050

Payment due dates on the last day of each month, payable in advance.