Application Form · Bellville Islamic Primary

بِسْمِ اللهِ الرّحْمٰنِ الرّحِيْمِ

Bellville Islamic Primary School

14 Hof Street, Northern Bellville, Cape Town, 7530 | albayaanwc@gmail.com

Learner Application Form

Passport
Photo

DECLARATION BY PARENT / GUARDIAN

I / We, the undersigned, confirm that all information provided in this application is true and correct. I / We understand that submission does not guarantee placement, and that the school reserves the right to accept or decline applications in accordance with its admission policy. I / We agree to uphold and support the school's Islamic ethos, rules, and code of conduct.

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Date Signed

Surname			First Name(s)
Known As			Gender	Male Female
Date of Birth		Age	SA ID / Birth Cert No.
Nationality			Home Language
Grade Applying For		Year	Previous School
Previous Grade		LURITS / EMIS No.	Reason for Leaving
Population Group	Somali Ethiopian Coloured African Indian / Asian White Other:

Street Address
Suburb	City	Postal Code
Postal Address (if different)

Relationship	Mother Father Guardian Other:
Full Name				ID Number
Cell No.		Work No.		Home No.
Email Address			Occupation
Employer / Company			Work Address

Relationship	Mother Father Guardian Other:
Full Name				ID Number
Cell No.		Work No.		Home No.
Email Address			Occupation

Full Name			Relationship
Cell No.		Home No.		Work No.

Medical Aid Name		Medical Aid Number
Doctor's Name		Doctor's Contact No.
Known Allergies	None Yes — specify:
Medical Conditions (asthma, epilepsy, etc.)	None Yes — specify:
Current Medication	None Yes — specify:
Learning Barriers / Special Needs	None Yes — specify:

Previously suspended or expelled?	No Yes	If yes, details:
How did you hear about our school?	Current parent Social media Mosque / community Flyer / poster Online search Other
Additional comments

Application Submitted!