APPLICATION FOR ADMISSION FOR 2023: GRADE

Today's Date (dd/mm/yyyy)

Granted Yes / No

FOR OFFICE USE ONLY Account No Amount

Admisson No Feedback

APPLICATION FOR ADMISSION FOR 2023: GRADE _________

This form must be completed by one of the parents/guardians, and not by the learner. Please print and complete the application in ink. Circle/mark where necessary and delete where not applicable.

NEW APPLICATIONS ONLY

Previous school and town

Reason why learner left the previous school (If the school was a secondary school) Highest grade passed (attach a copy of the latest examination results) Grade/s which the learner has already repeated (if any)

Have you also applied for hostel accommodation for this learner?

YES

NO

NB! If YES take note that a separate agreement for hostel accommodation is to be concluded with the school. A copy of the agreement is available at the administration office of Middelburg Ho?rskool.

I undertake to submit copies of the following documents with the application, and understand that no application will be accepted without any one of the documents listed below. If the surnames of the parents

differ in their respective ID documents, a marriage certificate must be attached. Learner's birth certificate

ID documents of BOTH PARENTS

Most recent Water and Lights account

Most recent examination results / academic record from previous school

Transfer certificate / documentation from previous school (if it is a high school)

Proof of achievements (where applicable)

Information about the learner

Surname

Full names

Name known by

Male / Female

Current grade

ID Number

Position of learner in the family (e.g. 2nd of 3)

Cell nr of Learner

Email of Learner

I, (Mr. / Mrs.)

the father/mother/legal guardian of the above

mentioned learner, request that he/she be admitted/re-admitted as a learner of Middelburg Ho?rskool (If legal guardian,

proof of guardianship is required).

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Father Mother Stepfather Stepmother Grand-father Grand-mother Uncle

Aunt Foster parent

Other (specify) Father Mother Stepfather Stepmother Grand-father Grand-mother Uncle

Aunt Foster parent

Other (specify)

B. Details of person responsible for the payment of the learner's school fees

Relationship to the learner (mark with an X)

A. Details of other parent / guardian This section must also be completed (if deceased, please make a note and attach a copy of the death certificate)

Relationship to the learner (mark with an X)

Title, initials and surname Full names ID Number Residential address

Postal address

Occupation Name of employer Employer's street address

Telephone no ? Work

Telephone no ? House Cellphone no Email address

Title, initials and surname Full names ID Number Residential address

Postal address

Occupation Name of employer Employer's street address

Telephone no ? Work

Telephone no ? House Cellphone no Email address

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C. Family or friend who can be contacted in case of an emergency

Brother Sister

Grandfather

Title, initials and surname

Residential address

Telephone no ? Work Telephone no ? House Telephone no ? Cellphone no Email address

Relationship to the learner (mark with an X)

Grand-

Uncle

Aunt Neighbour

mother

Friend of the family

Other (Specify)

Own father &

own mother

Mother (single parent, divorcee,widow)

Learner resides with

Father (single parent, divorcee,widower)

Mother & stepfather

Father & stepmother

Grandparent

Other family member (specify)

Brothers and/or sisters in Middelburg Ho?rskool (name and grade)

Other person (specify)

Church / Denomination

School Fees

According to the SA Schools Act, a parent or guardian who enroll a learner in a public school is legally obligated to pay the prescribed school fees before the 7th of each month.

. School fees are determined annually by the elected Governing Body, after drawing up a budget for the following year.

I take notice of the conditions mentioned above Signature of parent

? Please note some parents may, based upon the combined gross salary of both parents, qualify and apply for a partial or full exemption of school fees.

? Details of the criteria, the application procedure as well as the sliding scale, can be ontained from the school fees office. Applications for a subsidy must be handed in before 28 February of each year.

? The parent remains responsible for the payment of all school fees until the application is approved. ? The closing date for once off payments is at the end of February. Should you choose the option of monthly

instalments, the school fees are payable in 10 monthly payments, payable from January. ? While a reasonable period is given for payment of school fees, the full amount will become due and payable if the

parent falls behind with payments. This means that the full amount that was levied for the year, plus interest will be handed to the school's legal advisors for collection. ? Middelburg Ho?rskool's debt collection services are handled by Johan Coetzee Attorneys in Witbank. Overdue school fees (90 days) without prior arrangement will be handed over. Please contact Krisna Jenkins at Johan Coetzee Attorneys at (013) 650 3500 if your account has been handed over. Johan Coetzee Attorneys also handle the subsidy applications for 2023. Application forms are available at the school fees office. ? The school will not discriminate against any child on the grounds of the non-payment of fees by the parents, but parents should take notice of the following:

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If school fees in arrears are handed over to the school's legal representative for collection, I agree to the following ?

? If payments are not made in time, I agree to pay interest which will be levied within the framework of existing financial legislation. Should non-payment of school fees be handed over for collection to the school's legal advisors, I accept liability for payment of legal fees on the scale as between attorney and client as well as collection commission. I also agree that if this should happen, an amount equal to the monthly payment may be collected from my employer.

? I hereby specifically agree that the school shall be entitled to, at its sole discretion, to allocate any payment made towards such debits or outstanding amounts as the school may determine.

I take notice of the conditions mentioned above

Signature of parent

Will you be applying for exemption?

YES

NO

(NB! If YES, please note that said application must be handed in at the

school fees office by 28 February

Payment of School Fees (Initial at your chosen option)

Option 1 : Once Off Payment

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I undertake to pay the full amount before the end of February (a discount will be given if you select this option)

Option 2 : Monthly Payments I would like to pay the school fees in 10 equal payments from January to October

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Option 3 : Continuation of Debit Order I currently use a debit order to pay my account at Middelburg Ho?rskool, and would like to continue

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Option 4 : New Debit Order (If you have changed to another bank, or your bank account number has changed, please complete this

option as well)

I hereby request and authorize Middelburg Ho?rskool to debit my account at the following bank institution (or another bank or branch where I may transfer my account) as follows:

Divide the amount which is debited against my school fees account and instruct my bank to deduct it from my bank account on the first (1st) working day of each month.

I agree to pay any fees which my bank may charge with regard to this debit order. This auhorization may be cancelled by me, by giving Middelburg Ho?rskool written notice thirty (30) days in advance. Receipt of this authorization by Middelburg Ho?rskool, is regarded as receipt of it by my bank.

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Bank

Account No

Type of account (mark with an X)

The details of my bank account are as follows:

Branch

Branch Code

Cheque/Current

Transmission

Savings

Signature (as used for signing cheques or for the withdrawal of funds from savings account)

1. I declare that I am aware that a copy of Middelburg Ho?rskool's constitution is available for perusal during school hours.

2. I undertake to submit myself to the stipulations of the school's constitution. 3. I declare that all details supplied in this application are correct in all respects and that this document will form the basis

for the acceptance of said child as a learner of Middelburg Ho?rskool. 4. I declare that I am aware that the language policy of Middelburg Ho?rskool is Afrikaans. A limited number of learners

will receive education in English.

Application for MERIT DISCOUNT / SCHOLARSHIP on school fees for the year (NB! This is ALSO a survey for extracurricular participation)

PLEASE NOTE:

? Please attach proof of all achievements.

? Discount on school fees can be awarded for the achievement of provincial colours only in a school sport and as school activities.

? The grant of merit discount and scholarships will be in accordance with the merit policy of the school, (see below). The School Governing Body will grant approval and their decision will be final.

? Scholarships which are approved, will be followed up by a contract which must be signed by both parent and learner.

? Only achievements obtained during the year before admission to Middelburg Ho?rskool, will be considered for approval.

Merit Bursaries (discount on school fees) Head boy / girl of Primary school (> 300 learners) Head boy / girl of Middelburg Ho?rskool Deputy head leaders of (>300 learners) & Middelburg Ho?rskool Head boy / girl of Middelburg Ho?rskool hostel Dux learner of the previous year: Grade 7 (school >300 learners) for only Grade 8 year Dux learner of the previous year: Grade 8 to Grade 11 Top 10 of the previous year: Grade 7 (school >300 learners) to 11 (excluding Dux learner) Provincial colours in a school-related sport (previous year) A team Provincial colours in a school-related sport (previous year) B team Cultural achievement on provincial level (previous year) in accordance with MHS's Cultural policy

15 % 15 %

5 % 5 % 100% 15 % 10 % 10 % 5 % 10 %

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