Your Name: Email: Phone:
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:
Name: Telephone:
Additional information:
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