Afterschool Application Form

Afterschool Application form

All parents/ guardians who would like their child to enrol for our Afterschool Programme should complete the application forms. or simple download from our website. Also ensure that all relevant documents are submitted together with the application.

Download and complete the Learner Application Form

2022 Learner Application

Please complete the application form below

Type of Registration(Required)

New Application

Returning Application

Application for(Required)

Primary School

High School

Citizenship(Required)

South African Citizen

Non-South African Citizen

Learner Information

I have been with PYMA Since (Year)(Required)

Grade applying for(Required)

First name of Learner(Required)

Surname of Learner(Required)

Date of Birth(Required)

Age(Required)

Identity Number(Required)

Name of current school(Required)

Current Grade(Required)

Name of Class Teacher(Required)

School Phone Number(Required)

Home language of learner

Race (for statistics only)(Required)

Does the child have a social grant?(Required)

YES

How far from PYMA do you live? (Kilometers)(Required)

How will your child be travelling to PYMA(Required)

Parent and Legal Guardian Details

Relationship to child(Required)

Mother

Father

Grandparent with legal guardian role

Legal Guardian

Name(Required)

Prefix First Last

ID Number(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Live in same household with the child(Required)

Yes

Home Phone

Cell number(Required)

SMS communication to be sent to this number(Required)

Yes

Work number

Correspondence Email(Required)

If you do not have an email, please contact PYMA.

Second Parent / Legal Guardian(Required)

Yes

Additional Parent / Guardian

Relationship to child(Required)

Mother

Father

Grandparent with legal guardian role

Legal Guardian

Name(Required)

Prefix First Last

ID Number(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Live in same household with the child(Required)

Yes

Home Phone

Cell number(Required)

SMS communication to be sent to this number(Required)

Yes

Work number

Other Siblings at PYMA

Are there other siblings at PYMA?(Required)

Yes

Name

First Last

School Name

Grade

Additional sibling at PYMA(Required)

Yes

Name

First Last

School Name

Grade

Emergency Contact

(Relative/ friend, not living on same premises who could be contacted in case of an emergency if the parents cannot be reached)

Name(Required)

First Last

Relationship to Learner(Required)

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Home Phone

Cell Phone(Required)

Special and Medical Information

Please indicate any special medical attention required for the learner e.g. chronic allergies, asthma, use of wheelchair, hearing aid, FM system etc

Special information(Required)

Allergies(Required)

Please insert N / A if no allergies

Family Doctor name(Required)

Please insert N / A if no doctor

Doctor Phone Number

Completion

Application completed by:

First Last

Relationship to Learner

Parent and Guardian

Grandparent and Guardian

Legal Guardian

Date

Guardian Consent and Indemnity Form

As our services are professional, it is important that our resources and time are focused on the most committed learners. We also encourage active participation of parents/guardians through each term parental empowerment meetings, telephonic communication, and letters sent out regularly. For legal reasons, we ask that you please complete and return the following form.

I, (provide full names)(Required)

First Last

ID Number(Required)

Parent / legal Guardian of (learner name) :

First Last

hereby provide my consent for him/her to participate in the Phakamani Young Minds Academy Programmes.

Programme Consent(Required)

I understand that my child/ward has committed to attending Phakamani Young Minds Academy After school programmes.

Non attendance(Required)

I further understand that if his/her attendance is inadequate, he/she will no longer be offered our programmes or access to Phakamani Young Minds Academy resources.

Travel costs(Required)

I am willing and able to cover the costs of travel for my child/ward to attend all sessions during year until he/she completes grade 12

Media Consent(Required)

I hereby grant Phakamani Young Minds Academy permission to publish media (photos and videos), comments and/or work samples of my child/ward on their website, reports, advertising material (flyers/brochures), and social media.

Indemnity
I hereby acknowledge, agree and undertake that:

Participation(Required)

I willingly agree that my child or ward can participate in the Phakamani Young Minds Academy program activities as stated above and all related activities (transport to and from any event) and willingly accept all the risks associated therewith.

Liability(Required)

I hereby release Phakamani Young Minds Academy from all liability in respect of any claims, damages, injuries, losses, deaths, expenses and liabilities arising out of or in any way connected with participating in the Phakamani Young Minds Academy program including without limitation:

a) Any personal injury or loss of life;
b) Any loss of support, maintenance or other claims or damages arising from or connected with any personal injury or loss of life to my child/ward;
c) Any loss or damage to property belonging to a child/ward or any other third party.

Indemnity under this agreement covers the entire Phakamani Young Minds Academy project. This agreement must be completed in full, dated, signed and witnessed.

Terms and Conditions
1. We shall monitor your Child’s academic progress and produce regular written reports. We will advise you if we have any concern about your Child’s academic progress, but we do not undertake to diagnose any learning disability or other condition: a formal assessment can be arranged either by you or by the official School at your own expense.
2. In order to fulfil our obligations, we need your co-operation. Without detracting from any specific obligations contained in this agreement, you are required to: fulfil your own obligations under these terms and conditions; encourage your Child in his or her studies, and give appropriate support at home; keep PYMA informed of matters which affect your Child; maintain a courteous and constructive relationship with PYMA staff; and attend all meetings and otherwise keep in touch with PYMA where your Child’s interests require you to do so.

Consent to terms and conditions(Required)

I hereby accept and support the regulations contained in the terms and conditions of Phakamani Young Minds Academy, and I undertake to ensure that I comply and abide with the regulations.

Name(Required)

First Last

Learner Consent

Please take note of the consent and conditions which must be followed by each learner.

1. Absenteeism
All learners make a commitment to attend all tutoring sessions. If a learner is unable to attend a session they must:
a) Report in advance to the tutoring session starting, by telephone or in person to the programme coordinator and provide a valid reason for their absence.
b) Report after their absence with a signed letter from their parent or school stating the reason for such absence
c) Provide contact details of any teacher or parent who signs a letter of excuse and agree to them being contacted should there be any cause for doubt
All efforts should be made to attend every session. However, valid reasons for absence include:
- Doctors appointment – learners must provide a doctor’s note that states the time, date, and location of their appointment
- School extra classes – learners must provide a teacher’s note stating the reason for being kept behind at school as well as the time, date and location
- Emergency family responsibilities – learners must provide a parent/guardian’s note stating the reason for absence, and the time, date and location
If a valid absence is reported timeous in the manner set out above, it will result in attendance being recorded as 0,5points and contribute to the learner’s overall attendance score. If the absence is either invalid or is not reported in the manner set out above, the attendance will be recorded with 0 points.If a valid absence is reported timeous in the manner set out above, it will result in attendance being recorded as 0,5points and contribute to the learner’s overall attendance score.

2. Process
If learners miss more than two tutoring sessions the organisation has the right to call their stated parent/guardian to determine the reason for their absence.
Any learner whose attendance is dropping below 75% attendance will receive a warning within good time so that she/he is able to make a choice to improve their attendance before the kick-out date.

3. Reapplication
If a learner has been kicked-off the programme due to poor attendance or for another reason such as poor behaviour, that learner will not be allowed to reapply for the programme until one calendar year has passed. If the learner would like to reapply in the following year, they may do so but it will be at the discretion of the PYMA staff whether he/she should be accepted.

I fully understand the commitment requirement. I understand that in order to keep my place in the programme I must attend a minimum of 75% of the tutoring sessions in any term. I will receive a warning in the middle of the term if my attendance is less than 75% and will have the opportunity to improve my attendance before the end of the term. If at the end of term my attendance has been less than 75% for the term, I agree that this will result in being kicked-out of the programme and my place will be given to another learner on the waiting list. I agree that if I miss more than two tutoring sessions the organisation has the right to contact my parent/guardian to find out why I was not able to attend. I make this commitment as I understand that this will help me to improve my academic results and will assist the organisation to deliver the best programme for me.

Learner consent(Required)

Consent to the above

Learner Name(Required)

First Last

Date of learner consent

Document check list - to be uploaded(Required)

Please confirm that you have submitted the following documents

Learners birth certificate

Last school report card

Original Proof of residence

Parent / Guardian ID Copy

Agreement Letter for Learner to participate in the PYMA Programme

Document upload

Drop files here or

Max. file size: 6 GB.

Afterschool Application Form