Registration - Boorhaanol Islam Movement

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EMAIL

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Your Name:
Email:
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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:

Name: Telephone:

Name: Telephone:

Additional information:

196 Longmarket Street
Bo-Kaap, Cape Town
8001, South Africa

81 Dorp Street, Bo-Kaap
Cape Town, 8001
South Africa

Pentz Street, Bo-Kaap
Cape Town, 8001
South Africa

Phone: +27 21 424 1864
Email: info@boorhaanol.org.za

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