Centre: Centre address:
Registration or EMIS number: Date: Place:
| Parent or guardian | ID number | ||
| Physical address | Cellphone / alt contact | ||
| Learner and date of birth | Group and start date |
| Item | Amount | When / notes |
|---|---|---|
| Registration fee (once-off, not refundable) | R | On signature |
| Monthly fee | R | Day of each month, in advance |
| Departmental subsidy, approved subsidised place (paid to the centre, not by you) | R24 per day attended | Balance payable by parent: R |
| Late collection after | R per 15 min | Added to next statement |
Monthly fee in words:
The fee covers care and the daily programme from to , Monday to Friday, meals as per the menu, and classroom consumables. It does not cover . Fees are payable monthly in advance for twelve months of the year and are not reduced for absence, illness, public holidays or centre holidays.
| Bank and account name | Account number / branch | ||
| Payment reference (use on every payment) | |||
The reference field is usually all that appears on the centre's bank statement. Your own account name often does not show at all. A deposit without the reference above cannot be allocated to this learner, and the account will show as unpaid until proof of payment is produced. Save the centre as a beneficiary with the reference stored. Cash is taken at the office only, against a numbered signed receipt.
| Parent or guardian signature Name: Date: |
For the centre Name and position: Date: |
| I received a signed copy of this agreement. Parent signature: Date: | |
This is the centre's own contract with the parent. It is not a government form. Keep the signed original in the learner's file and give the parent a copy.