High School Online Application High School Application Step 1 of 6 16% This form must be accompanied by a R200,00 application feeApplication for Grade89101112For Year20172018Admission No.ClassApplicant's Full NamesFirstLastDate of Birth NationalitySouth AfricaAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayNorthern Mariana IslandsOmanPakistanPalauPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbia and MontenegroSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabweHome LanguageID/Passport NumberGenderMaleFemaleMath-habHanafiShaafiPermanent Address of LearnerStreet AddressAddress Line 2CityZIP / Postal CodePhoneMobileTermporary Address of LearnerStreet AddressAddress Line 2CityZIP / Postal CodePhoneMobileWith whom does the child stay?Both ParentsMotherFatherOtherIf other, please provide detailsFull NamesFirstLastRelationshipAddressStreet AddressAddress Line 2CityZIP / Postal Code Family InformationFatherMarriedRemarriedWidowedGuardianDivorcedSeperatedSingleFather's NameFirstLastAddressStreet AddressCityZIP / Postal CodeHome TelCell NoPostal AddressStreet AddressCityZIP / Postal CodeID NumberOccupationCurrent EmployerType of BusinessBusiness AddressStreet AddressCityZIP / Postal CodeWork PhoneFaxEmailAccountAccount / Correspondence to be addressed toNext of kinNameFirstLastRelationshipAddressStreet AddressCityZIP / Postal CodePhone Family InformationMotherMarriedRemarriedWidowedGuardianDivorcedSeperatedSingleMother's NameFirstLastAddressStreet AddressCityZIP / Postal CodeHome TelCell NoPostal AddressStreet AddressCityZIP / Postal CodeID NumberOccupationCurrent EmployerType of BusinessBusiness AddressStreet AddressCityZIP / Postal CodeWork PhoneFaxEmailAccountAccount / Correspondence to be addressed toNext of KinNameFirstLastRelationshipAddressStreet AddressCityZIP / Postal CodePhoneNumber of Children in FamilySiblings' DetailsNameGradeCurrent School Islamic Education and Extramural ActivitiesIslamic EducationDoes the learner attend Madressa?YesNoWhere does the learner attend Madressa?*Can the learner read the Qur'an?YesNoFluently?YesNoIf not, please explain.Is the learner aware of the basic laws of Fiqh?YesNoWho has been responsible for the moral training of the learner? Specify.Preferred Math-hab for Learner's TuitionHanafiShaafiExtramural Activities (All learners are expected to participate in sport and/or cultural activities)List the cultural activities that the learner currently participates in List the sport activities that the learner currently participates in Leadership (Mention any position of leadership or responsibility) School FeesWho will be responsible for School Fees?FatherMotherOtherDetails of Payer if Other than Parent or GuardianNameFirstLastMarital StatusMarriedRemarriedWidowedGuardianDivorcedSeperatedSingleID NumberOccupationCurrent EmployerWork TelFaxCell NoEmailHome Address if Different from LearnerStreet AddressCityZIP / Postal Code MedicalDoes your child suffer from Asthma, Epilepsy or any other illness? Is your child allergic to anything? Any other medical conditions that the school should be aware of?N.B. Immunisation against Poliomyelitis and Tuberculosis (BCG) is compulsory by statute.We hereby certify that the information given by us on this application form is complete and accurate. We agree to the conditions as set out below.*ConfirmCONDITIONS OF ACCEPTANCE OF PLACEWe are aware that a term’s notice must be given before a learner leaves N.I.S or a full term’s fees must be paid in lieu thereof. In addition to the tuition fees charged by N.I.S, we agree that we shall be liable to pay any increases in such fees or any levy imposed by N.I.S.We accept joint and several liability to N.I.S. for the due and punctual payment of all school fees, subscriptions, levies or other amounts which may become due and payable to N.I.S. or in respect of participation or attendance in any extra-curricular activity.All learners are subject to the regulations, rules and routine of the school as laid down by the head. Parents undertake to co-operate with the school authority in enforcing them.The parent / guardian accept the authority of the Principal and teachers.Should a learner be removed from the school by reason of breach of school rules, the parent shall remain liable for fees due for the full term during which the learner was removed, and if such fees have been paid the school shall not be obliged to refund any portion thereof.The school will not be held liable for any loss of learners’ possessions.A full term’s notice of withdrawal shall be given in writing to the head, whether such notice is to be effective during the currency of the school year, or one full term’s fees must be paid in lieu for such notice.One full month’s fee is payable in the event of withdrawal between the date of acceptance of a place offered and the beginning of term.In the event of the school having to institute action to recover fees, the parents shall be liable to make payment of all costs incurred by the school, as between attorney and client.In the event of action being instituted for outstanding fees, the parents will consent to the jurisdiction of the magistrate’s court.Fees for each quarter should be payable at the beginning of each term.If you have more than one child at the school you are also entitled to a discount – (contact school bursar).NB: WARNING: Any fraudulent information with regard to Home address, Date of Birth, etc. can result in the child being asked to leave the School as soon as this becomes known.