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About Us
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ECD
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Vicky’s Multi Products & Services
School Readiness & Development Support
Creative arts
Contact Us
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About Us
Kingdom Academy Appllication Form
📝 Kingdom Academy Crèche Application Form
Full Name Of Child
Date Of Birth
Gender
Female
Male
Home language(s)
Nationality
Physical Address
Birth Certificate Number
Medical Aid Name & Number (if applicable)
Allergies or Medical Conditions (if any)
Immunisation History (Up to date? Yes/No)
Yes
No
Doctor's name and contact number
Section 2: Parent/Guardian Information
Parent/Guardian 1
Full Name
Relationship to Child
ID Number
Contact Number
Email Address
Home Address (if different from child)
Occupation & Employer
Work Contact Number
Parent/Guardian 2 (optional)
Full Name
Relationship to Child
ID Number
Contact Details
Occupation & Employer
Section 4: Programme Information
Preferred Starting Date
Relationship to child
Age Group/Class Applying For:
0 – 18 months (Baby Class)
18 months – 3 years (Toddler Class)
3 – 4 years (Pre-ECD)
4 – 5 years (Grade R Prep)
Contact numbers
Days Required:
Full Week (Mon–Fri)
Selected Days (specify)
Authorized to collect the child? (Yes/No)
Yes
No
Selected Days
Monday
Tuesday
Wednesday
Thursday
Friday
Time Options:
Full Day
Half Day
Extended Aftercare (if offered)
Monday
Tuesday
Wednesday
Thursday
Friday
Section 5: General Consent & Permissions
May we take photos of your child for learning reports or school events? (Yes/No)
Yes
No
Do you give permission for emergency medical treatment if needed? (Yes/No)
Yes
No
Who is authorized to collect your child? (List names and contact details)
How did you hear about Kingdom Academy? (Friend, Social Media, Website, etc.)
Section 6: Parent Declaration
I confirm that the information provided is true and complete.
I confirm that the information provided is true and complete.
I agree to comply with Kingdom Academy’s rules, policies, and fee structure.
Signature
Date
Submit
If you are human, leave this field blank.