First Name(s): Surname:
Birthdate:

Group: Tiny TotsPreschoolers (Grade R)JuniorsAdvanced Preschoolers (Grade R+)
Home Language: EnglishAfrikaansXhosaOther
If "Other", please specify:

Potty Trained: YesNo
Vaccinated: YesNo
Vaccinated against: MeaslesChicken PoxMumpsGerman Measles
Allergies:

Family Doctor

Name: Telephone:

Next of kin (if parents are not contactable)

Name: Telephone: