Johannesburg Polytech Institute

Online Registration Form

PLEASE FILL IN THE FORM BELOW IN CAPITAL LETTERS (BLOCK CAPITALS)

Please fill in the form below and click submit. You will be contacted later to make arrangement for paying the registration fees. Make sure you read the rules and regulations of the school plus the fees structure before you fill in this form. Should you be in doubt please request for more information or visit us for an orientation.

PERSONAL INFORMATION
Email Address
Registration Date
Students Surname
First Names
Preferred Name
Gender
Date of Birth
Age
Position In Family
ID or Passport Number	NB: If you are a foreign student please make sure you have the necessary study permit from the Department of Home Affairs South Africa
Home Language
Religion
Residential Address Residential Address Continued
Residential Postal Code
Postal Address Postal Address Continued
Postal Code
Last School Attended
Last Grade Done
Grade Currently Being Registered
Student Interests e.g. Soccer
Do you do Supervised Homework
Person to Pick Student from School
Means of Getting Home
Notes About the Student
Special Skills e.g. Carpentry, Arts
Further Comments
MEDICAL INFORMATION
Physical Conditions e.g. Physically Disabled
Do you attend External Therapy
Therapist Name
Dates for Therapist
Therapist Contact Number
Chronic Medication
Emergency Contact Person
Home Emergency Number
Office Emergency Contact Number
FAMILY INFORMATION
Student Lives With e.g. Mother and Father
Mother's Surname
Mother's Other Names
Mother's Physical Address
Father's Surname
Father's Other Names
Father's Physical Address
Guardian's Surname
Guardian's Other Names
Guardian's Physical Address
Mother's Home Number
Mother's Work Number
Mother's Cell Number
Mother's Occupation
Father's Home Number
Father's Work Number
Father's Cell Number
Father's Occupation
Guardian's Home Number
Guardian's Work Number
Guardian's Cell Number
Guardian's Occupation
Who Pays Fees (Full Name)

By clicking submit, you declare that you will abide by the rules and regulations of the school.