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Details of Learner
Registration for Grade
Pre-R (Age 4-5)
Grade R
Grade 1
Grade 2
Grade 3
Grade 4
Grade 5
Grade 6
Grade 7
Year of Registration
2026
2027
2028
Surname
*
Full First Name
*
Date of Birth
Gender
Male
Female
ID Number
Medical History
State any important illness which the Applicant has suffered / suffers (e.g. Asthma, Allergies etc)
Any other relevant information
Name and address of previous school attended by applicant (if applicable)
Name of School
Address of School
Contact number of school
To Grade
From Grade
Has the applicant ever required remedial intervention: Occupational Therapy, Physiotherapy, Psychological Assessment or any other therapy?
*
We reserve the right to cancel your child's admission to Grassroots Preparatory for non-disclosure of the above information and/or documents.
Yes
No
If Yes, Please supply details:
Details of Parents / Guardians
Full Name and Surname of Father
ID Number
Career
Email Address
Residential Address
Street Address
Apt, Suite, Bldg. (optional)
City
State / Province / Region
Postal / Zip Code
Afghanistan
Albania
Algeria
Andorra
Angola
Antigua and Barbuda
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Central African Republic
Chad
Chile
China
Colombia
Comoros
Congo (Brazzaville)
Congo
Costa Rica
Cote d\'Ivoire
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor (Timor Timur)
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Fiji
Finland
France
Gabon
Gambia, The
Georgia
Germany
Ghana
Greece
Grenada
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Korea, North
Korea, South
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Zealand
Nicaragua
Niger
Nigeria
Norway
Oman
Pakistan
Palestinian Territory
Palau
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Qatar
Romania
Russia
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
Spain
Sri Lanka
Sudan
Suriname
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States of America
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Western Sahara
Western Samoa
Yemen
Zambia
Zimbabwe
Country
Tel No. (W)
(H)
(Mobile)
Full Name and Surname of Mother
ID Number
Career
Email Address
*
Residential Address
Street Address
Apt, Suite, Bldg. (optional)
City
State / Province / Region
Postal / Zip Code
Afghanistan
Albania
Algeria
Andorra
Angola
Antigua and Barbuda
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Central African Republic
Chad
Chile
China
Colombia
Comoros
Congo (Brazzaville)
Congo
Costa Rica
Cote d\'Ivoire
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor (Timor Timur)
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Fiji
Finland
France
Gabon
Gambia, The
Georgia
Germany
Ghana
Greece
Grenada
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Korea, North
Korea, South
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Zealand
Nicaragua
Niger
Nigeria
Norway
Oman
Pakistan
Palestinian Territory
Palau
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Qatar
Romania
Russia
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
Spain
Sri Lanka
Sudan
Suriname
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States of America
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Western Sahara
Western Samoa
Yemen
Zambia
Zimbabwe
Country
Tel No. (W)
(H)
(Mobile)
*
Marital Status
Married
Divorced
Widowed
Preferred contact for general communication from school
Mother
Father
Both
Preferred contact for school accounts
Mother
Father
Both
Where did you hear about us
FaceBook
Instagram
WhatsApp
Google Search
Radio Advertisments
Advertising through local school network
Word of Mouth
Other
If "other" was ticked above, please elaborate
The Following Must Accompany This Application (If unable to attach the documents below, please email them to admin@grassrootsprep.co.za)
Copy of applicant's birth certificate
Yes
No
File Upload - Pdf, Jpeg, Png
Copy of applicant's last report
Yes
No
File Upload - Pdf, Jpeg, Png
Copy of assessments (if applicable)
Yes
No
File Upload - Pdf, Jpeg, Png
Copy of Father's ID
Yes
No
File Upload - Pdf, Jpeg, Png
Copy of mother's ID
Yes
No
File Upload - Pdf, Jpeg, Png
Proof of address
Not older than 3 months
Yes
No
File Upload - Pdf, Jpeg, Png
Proof of payment of the non-refundable administration fee of R550.
Yes
No
File Upload - Pdf, Jpeg, Png
Please indicate if after school care will be required
If yes, please contact the school for after school care registration forms.
Yes
No
Acceptance of this application does not imply final acceptance of applicant. Scheduled interviews with parents and learners form part of the application process.
Declaration Agreement
*
I understand that this application will only be processed once the application form is returned to the school with ALL the relevant documentation attached.
I accept
*
I hereby consent to a credit check conducted by Grassroots Preparatory
I accept
Date of Application submission
Banking Details
Bank Details
(Please use your child's name and surname as a reference) ACCOUNT NAME: The Grassroots Preparatory BANK: Standard Bank ACCOUNT NUMBER: 271 799 145 BRANCH: Kenilworth Centre BRANCH CODE (ELECTRONIC PAYMENTS): 051001 BRANCH CODE: 026209 ACCOUNT TYPE: Current Account
*
If you are applying during 2025, then upon Acceptance, January 2026 tuition fees plus an additional R2 500 placement fee must be paid to secure your child's place at the school. Should you decide NOT to join Grassroots in January 2026 then your first month's fees (January 2026) as well as the placement fee becomes non-refundable.
I accept
Verification
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