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PowerEd Sign-Up Form
Please complete this form to sign your child up for PowerEd
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to save your progress.
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* Indicates required question
Child's Name & Surname
*
Your answer
Child's School
*
Your answer
Child's Grade
*
R
1
2
3
Other:
Parent / Guardian's Name & Surname
*
Your answer
Parent / Guardian's Email
*
Your answer
Parent / Guardian Phone Number
*
Your answer
Alternative Contact Person Name & Surname
*
Your answer
Alternative Contact Person Phone Number
*
Your answer
Medical Aid Name
Your answer
Medical Aid Membership Number
Your answer
Does your child have any allergies / medical conditions we should know about? If yes, please detail below as well as any medication used.
Your answer
Does your child need to go to After Care after PowerEd?
*
Yes
No
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