Grosvenor Academy

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Child Information

First Name* Last Name Preferred Name

Home Language Date of Birth Gender

Mum Information

First Name Last Name Date of Birth ID Number

Mobile Work Number Home Number Email

Home Address Work Address

Dad Information

First Name Last Name Date of Birth ID Number

Mobile Work Number Home Number Email

Home Address Work Address

Medical Information

Medical Aid Package Membership No Primary Member

Doctor Name Doctor Contact Number

Allergies Medical Conditions Chronic Medication Special Dietary Requirements

Emergency Information

First Name Last Name Relationship Contact Number

Allowed To Pickup

First Name Last Name Relationship Contact Number

Billing Information

Responsible For Accounts* Grade / Service Group* Package* Extra Programs

Online Access

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Digital Signature*

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Accept Terms & Conditions

I accept the terms and conditions* I give consent for photographs of my child to be taken and used for school-related purposes, including editorial content for local, provincial and national media; the school's official social media platforms; and the school's academic records, newsletters, yearbooks, and notice boards.

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