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CHILD INFORMATION
Full names
Date of Birth
Gender
Male
Female
Home language
Email
Care schedule
Day Care
Night Care
Both
PARENT OR GUARAGIAN DETAILS
Parent/Guardian full names
Relation to the child
Mother
Father
Legal Guardian
Other
Parent/guardian ID or passport number
Cellphone number
Email
Residential address
Employer’s name
Workplace address
ALTERNATIVE EMERGENCY CONTACT
Emergency contact’s full name
Relationship to child
Emergency cellphone number
Address of the alternative emergency person
MEDICAL AND HEALTH INFORMATION
Family doctor’s name
Family doctor’s telephone number
Medical aid plan or option
Medical aid membership number
Known allergies
Chronic medication or special conditions
Dietary requirements
Halaal
Vegetarian
Other
Additional care instructions
CONTACT PREFERENCE AND ADDITIONAL INFORMATION
Preferred contact method
Phone
Email
WhatsApp
Additional message or questions
CONSENT AND DELCARATION
POPIA consent
I confirm that the information provided is accurate, and I consent to Pressmore Night and Day Care securely collecting, storing and processing this information for enrolment, childcare and communication purposes in accordance with the Protection of Personal Information Act (POPIA).
Fees and terms agreement
I confirm that I have read and agree to the applicable monthly fee structure and Pressmore Night and Day Care’s enrolment terms and conditions.
Application date
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