Curro Enrolment Form
Curro Holdings Ltd/Reg. no. 1998/025801/06/VAT Reg. no. 4670183484
School name Curro Westbrook Promo/employee no.
Year applying for 2027-01-08
Family code (existing parents only)
Necessary supporting documents, completed sections and forms
This application will be processed only if all fields are legibly completed, are signed, and all supporting documents are
attached
Copy of learner's birth certificate/ID Copy of learner's latest progress report
Copy of parents'/legal guardians' IDs Copy of learner's FINAL progress report once available
Proof of residence/study permit, if foreign Subject choice form (for Grades 10 to 12)
Copy of learner's vaccination records (up to Gr 3) Completed boarding application form (if applicable)
Completed and signed debit order form All sections completed and signed
Two recent ID photos of learner
Application details
Please confirm availability at the school.
Preschool group: 1 2 3 4 5 Half day Full day
Grade: R 1 2 3 4 5 6 7 8 9 10 11 X
Learner details
Surname Roman
Name/s as on birth certificate/ID Taylon
Preferred name Andrea
ID number 1 0 0 5 1 9 1 0 3 0 0 8 7
Date of birth 2010-05-19 Current age 16 Gender: Male Female X
Home language AFRIKAANS Second language
1st teaching language ENGLISH 2nd teaching language AFRIKAANS
Nationality South Africa Country of origin South Africa Immigration date 2010-07-06
Race: Asian African Coloured X White Indian Other
Resides with: Parents X Guardian Boarding
For office use
Interview date Approved Y N Family code
Notes Date approved Credit reference
Commencement date Siblings at the school 1
Group/Grade Siblings at the school 2
Learner details (continued)
Religion Christian Mode of transport
Person dropping learner at school (preschool to Gr 7) Person collecting learner from school (preschool to Gr 7)
Name Name
Relationship Relationship
*Please note that the availability of aftercare, boarding school and school transport may vary based on the school.
Aftercare
Are you interested in aftercare? Yes No
Boarding school accommodation
Are you interested in boarding facilities? Yes No
School transport
Are you interested in school transport? Yes No Route /Pick-up point
Learner’s education details
Current school Despatch High School Tel no. 27 419335104
Last grade passed Grade 9 Year 2025 Grade/s repeated
Has admission to any other school/s ever been refused? Yes No X
If yes, please state the reason below:
Learner's medical details
Blood type: O+ O- A+ A- AB+ AB- B+ B- Unknown X
Family doctor
Name Tel no.
Address
Medical aid
Name NONE Member no. None Option
Main member initials and surname None
Main member ID number N o n e
Learner's medical details (continued)
Has the learner received all the necessary immunisations? Yes No X
If no, please state the reason below:
Yes
Has the learner suffered from any of the following illnesses? Please indicate with an X.
Asthma Chickenpox Diabetes Diphtheria
Enteric fever German measles Hepatitis Malaria
Measles Mumps Polio Rheumatic fever
Scarlet fever Tick bite fever Typhoid fever Whooping cough
Does the learner suffer from any allergies? Yes X No
If yes, please provide details below:
mosquitoes
Does the learner have any special medical needs? Yes X No
If yes, please provide details below:
pills her pills
Does/Has the learner suffered from any other illnesses/disabilities? Yes No X
If yes, please provide details below:
Is the learner receiving medical treatment for any condition? Yes No X
If yes, please provide details below:
Is/Has the learner suffered from or received treatment for any psychological/emotional upset? Yes X No
If yes, please provide details below:
went to therapy for own personal reasons
Has the learner had any operations? Yes No X
If yes, please provide details below:
Please specify any other relevant medical details:
Consent to act in a medical emergency
In a critical medical situation, please bear in mind that there may not be time to refer to the learner’s records. The
school, therefore, reserves the right to utilise the quickest medical service available.
I, /mt#1#150#15/ , being the parent/legal guardian of /mt#1#140#15/ , hereby agree
that a medical practitioner may provide emergency treatment as may be necessary.
/s#1#160#50/
/d#1/
Signature of parent/legal guardian Date
Personal details of parent/legal guardian (1)
Complete only if NOT the account holder
Surname Welman
Full names as on ID Francis
ID number 7 8 0 5 0 3 0 0 5 8 0 8 0
Designation Mr Mrs Ms X Miss Dr
Rev. Prof. Other
Relationship Mother Marital status Widowed
Occupation Spar Employer Cashier
Residential address Work address Postal address
Korhaan Way 22 , None
Resevoir Hills
Despatch
Eastern Cape
6220
Tel. H Tel. W ZA 860313141 Cell 27 0711656046
Email address franciswelman@[Link]
Parental status Learner living with parent/s X Learner’s legal guardian
Access rights to learner Access rights in emergency only
Personal details of parent/legal guardian (2)
Complete only if NOT the account holder
Surname
Full names as on ID
ID number
Designation Mr Mrs Ms Miss Dr
Rev. Prof. Other
Relationship Marital status
Occupation Employer
Personal details of parent/legal guardian (2) – (continued)
Residential address Work address Postal address
,
Tel. H Tel. W Cell
Email address
Parental status Learner living with parent/s Learner’s legal guardian
Access rights to learner Access rights in emergency only
Emergency contact details (not parental)
Full names and surname Francis, Welman
Tel. H Tel. W Cell 27 0711656046
Relation to learner Mother
Email address franciswelman@[Link]
Details of person responsible for account
Surname Welman
Full names as on ID Francis
ID number 7 8 0 5 0 3 0 0 5 8 0 8 0
Designation Mr Mrs Ms X Miss Dr
Rev. Prof. Other
Relationship Mother Marital status Widowed
Occupation Spar Employer Cashier
Residential address Work address Postal address
Korhaan Way 22 , None
Resevoir Hills
Despatch
Eastern Cape
6220
Tel. H Tel. W ZA 860313141 Cell 27 0711656046
Email address franciswelman@[Link]
Parental status Learner living with parent/s X Learner’s legal guardian
Access rights to learner Access rights in emergency only
Relation to learner Mother
Details of children in your care who are currently at this school:
1. Name Gr 2. Name Gr
3. Name Gr 4. Name Gr
Payment option Monthly debit order Please complete the debit order form.
Signature of parents/legal guardians and account holder
We, the undersigned parents/guardians, hereby certify that the information provided in this
application for admission is complete and accurate. We acknowledge that enrolment is subject to,
inter alia, signing a learner admission contract that contains the detailed terms, conditions and
requirements for admission.
We acknowledge that we have read the school-specific policies and school rules and will accept an
offer of placement for our child at the school in accordance with the terms and conditions as set out
therein. These documents, as amended from time to time, are available on the official school website.
We further consent to the processing of personal information contemplated in the POPI Act No 4 of
2013, for the following purposes: evaluation of this application form; administration of the contract
between us and Curro Holdings; and conducting credit enquiries.
NB: The signatures of the account holder and both parents and/or legal guardians are required where applicable.
/s#1#160#50/
/d#1/
Signature of account holder Date
/s#1#160#50/
/d#1/
Signature of parent/legal guardian (1) Date
Date
Signature of parent/legal guardian (2)
Survey
Where did you hear about us?
Billboard Newspaper Magazine Radio Presentation
Friend Brochure Flyer Exhibition Web
Other (specify):
How satisfied were you with the service you received pre-enrolment?
Very satisfied X Satisfied Unsatisfied Very unsatisfied
Was the information received pre-enrolment …
Relevant Informative X Sufficient Other
What made you choose our school? Please indicate your five top reasons by checking the boxes below.
Academic standards X Affordability X Boarding facilities X
Bursary or scholarship received Bus routes Class sizes
Christian values (ethics and morals) Facilities Final examination
Focus on holistic child development Independent school Language offered
Learner discipline Learning environment Location and accessibility
Online school offered Performing arts and culture offered Safety and security
School heritage and culture X Sports offered Subject choices offered
Teachers