Grosvenor Academy REGISTRATION

1. Complete the details below and submit
2. A contract will be sent to you for completion and signature. Please initial each page and sign where require.
3. The signed contract is to be e-mailed to us with the requested supporting documentation.
4. You will receive an invoice with the registration fee. Please e-mail us proof of payment.
5. Your registration with GA is concluded.

First Name

Last Name

Preferred Name

Home Language

Date Of Birth

Gender Boy Girl

First Name

Last Name

Date Of Birth

Id Number

Mobile Contact Number

Work Contact Number

Home Contact Number

Email Address

Home Physical Address

Work Physical Address

Occupation

Employer Name

Employer Contact Number

First Name

Last Name

Date Of Birth

Id Number

Mobile Contact Number

Work Contact Number

Home Contact Number

Email Address

Home Physical Address

Work Physical Address

Occupation

Employer Name

Employer Contact Number

Medical Aid Name

Package Type

Membership Number

Primary Member

Doctor Name

Contact Number

Allergies

Medical Conditions

Chronic Medication

Special Dietary Requirements

First Name

Last Name

Relationship

Contact Number

First Name

Last Name

Relationship

Contact Number

Responsible For Accounts Mum Dad

Select Services View Pricing Toddler Group Pre-school Group Stages 1 - 6 Stages 7 - 9 IGCSE Aftercare (External) Aftercare (Internal)

Extra Programs No Yes

Email Address

Password

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