I would like my child to attend Shining Stars from:*

Name of child	:	*
Surname	:	*
Age	:	*

Gender:

Date of birth:

*

I would like my child to attend Shining Stars:

Telephone Number:

Cellphone Number:  *

E-mail:                        *

Street Address:          *

Postal Address:          *

Father's Details

Name:                          *

Employers Name:     *

Telephone Number: *

Mother's Details

Name:                         

Employers Name:     

Telephone Number:

Home Language:       *

Church Affiliation:    *

Does child wear nappies?:

                                     

Does child use bottle?:

                                     

Does your child have any food allergies?:

                                     

Family Doctor:           

Doctor Telephone Number:

Are parents divorced:

If yes, which parent has Custody?

Contact Person in Lieu of Parents:

Telephone Number: 

I agree that all the information is correct and I am aware of all the implications of applying for my child to attend Shining Stars Pre-School and Daycare.:

                                       

R500 Registration Fee