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The Blessed Joseph Gerard Aftercare Centre 2022 Registration Form
Please click on the link below for Aftercare information:
https://www.stbenedicts.co.za/juniorpreparatory/Aftercare
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Email
*
Your email
To register, please complete the below Google Form (one for each child)
Son's Name and Surname
*
Your answer
Son's Date of Birth
*
Your answer
Son's Grade in 2022
*
Your answer
PARENT 1 / GUARDIAN DETAILS
Full Name
*
Your answer
Cell Number
*
Your answer
Landline
Your answer
Email Address
*
Your answer
PARENT 2 / GUARDIAN DETAILS
Full Name
Your answer
Cell Number
Your answer
Landline
Your answer
Email Address
Your answer
EMERGENCY CONTACT PERSON
Other than Parent 1/Guardian or Parent 2/Guardian
Full Name
*
Your answer
Contact Number
*
Your answer
MEDICAL INFORMATION
Doctor's name and contact number
*
Your answer
Medical Aid
*
Your answer
Medical Aid Member Number
*
Your answer
Please list any medical conditions including all allergies
Your answer
If anyone else besides yourself is to collect your child from Aftercare you will need to inform us prior to the arrangement as we will not allow your child to leave the Aftercare without your permission.
Please list persons authorised to collect your child, include full names, phone number and their relationship to your son
Your answer
Please list persons NOT authorised to collect your child and their relationship to your son
Your answer
General information about your child (anything that the Aftercare needs to know)
Your answer
Parent/Guardian full name
*
Your answer
A copy of your responses will be emailed to the address you provided.
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