{"id":1988,"date":"2026-02-14T09:59:44","date_gmt":"2026-02-14T09:59:44","guid":{"rendered":"https:\/\/lsbekker.co.za\/?page_id=1988"},"modified":"2026-02-14T10:10:55","modified_gmt":"2026-02-14T10:10:55","slug":"learskool-bekker-application-form","status":"publish","type":"page","link":"https:\/\/lsbekker.co.za\/index.php\/learskool-bekker-application-form\/","title":{"rendered":"Learskool Bekker Application Form"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"1988\" class=\"elementor elementor-1988\">\n\t\t\t\t<div class=\"elementor-element elementor-element-4cdc367 e-flex e-con-boxed e-con e-parent\" data-id=\"4cdc367\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-2b655d5 elementor-widget elementor-widget-html\" data-id=\"2b655d5\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"html.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"forminator-ui forminator-custom-form forminator-custom-form-1743 forminator-design--basic forminator-custom forminator_ajax\" data-forminator-render=\"0\" data-form=\"forminator-module-1743\" data-uid=\"69f332880c8bd\"><br\/><\/div><form\n\t\t\t\tid=\"forminator-module-1743\"\n\t\t\t\tclass=\"forminator-ui forminator-custom-form forminator-custom-form-1743 forminator-design--basic forminator-custom forminator_ajax\"\n\t\t\t\tmethod=\"post\"\n\t\t\t\tdata-forminator-render=\"0\"\n\t\t\t\tdata-form-id=\"1743\"\n\t\t\t\tenctype=\"multipart\/form-data\" data-color-option=\"theme\" data-design=\"basic\" data-grid=\"custom\" style=\"display: none;\"\n\t\t\t\tdata-uid=\"69f332880c8bd\"\n\t\t\t><div role=\"alert\" aria-live=\"polite\" class=\"forminator-response-message forminator-error\" aria-hidden=\"true\"><\/div><div class=\"forminator-row\"><div id=\"section-5\" class=\"forminator-field-section forminator-col forminator-col-12 \"><div class=\"forminator-field\"><h2 class=\"forminator-title\">Application for Bekker Primary<\/h2><h3 class=\"forminator-subtitle\">Please complete the form below. Note that the fields will automatically update based on your selections (e.g., School or Hostel, New Application or Re-application). Please follow all instructions carefully as they appear.<\/h3><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"section-7\" class=\"forminator-field-section forminator-col forminator-col-12 \"><div class=\"forminator-field\"><h2 class=\"forminator-title\">Documents to Upload:<\/h2><h3 class=\"forminator-subtitle\">Please ensure you have clear, certified copies of the Learner\u2019s Birth Certificate, Latest Report Card, Parent\/Guardian IDs, and Proof of Residence\/Work Address ready.<\/h3><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"group-4\" class=\"forminator-field-group forminator-col forminator-col-12 \"><label class=\"forminator-label forminator-repeater-label\">SECTION A: LEARNER(S) DETAILS<\/label><span class=\"forminator-description forminator-repeater-description\">This form must be completed in full by the Parent, Guardian or Proxy.<\/span><div class=\"forminator-all-group-copies forminator-repeater-field\"><div class=\"forminator-grouped-fields\" data-options=\"{&quot;is_repeater&quot;:true,&quot;min_type&quot;:&quot;custom&quot;,&quot;max_type&quot;:&quot;custom&quot;,&quot;min&quot;:1,&quot;max&quot;:3,&quot;add_text&quot;:&quot;Add Learner&quot;,&quot;remove_text&quot;:&quot;Remove item&quot;,&quot;action_element_type&quot;:&quot;button&quot;}\"><div class=\"forminator-row\"><div id=\"select-11\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-1743__field--select-11_69f332880c8bd\" id=\"forminator-form-1743__field--select-11_69f332880c8bd-label\" class=\"forminator-label\">Application Type <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-1743__field--select-11_69f332880c8bd\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-11\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Please select one of the following options\" data-search=\"false\" data-search-placeholder=\"Please select one of the following options\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-1743__field--select-11_69f332880c8bd-label\"><option value=\"\"  >Please select one of the following options<\/option><option value=\"one\"  data-calculation=\"0\">New Applicant (First time applying to this school)<\/option><option value=\"two\"  data-calculation=\"0\">Returning Learner (Previously or currently enrolled)<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-8\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-1743__field--select-8_69f332880c8bd\" id=\"forminator-form-1743__field--select-8_69f332880c8bd-label\" class=\"forminator-label\">Applying for Hostel? <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-1743__field--select-8_69f332880c8bd\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-8\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Please select one of the following options\" data-search=\"false\" data-search-placeholder=\"Please select one of the following options\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-1743__field--select-8_69f332880c8bd-label\"><option value=\"\"  >Please select one of the following options<\/option><option value=\"one\"  data-calculation=\"0\">Yes<\/option><option value=\"two\"  data-calculation=\"0\">No<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-18\" class=\"forminator-field-text forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-18_69f332880c8bd\" id=\"forminator-field-text-18_69f332880c8bd-label\" class=\"forminator-label\">Learner Full Name &amp; Surname <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-18\" value=\"\" placeholder=\"Enter the name of the child\" id=\"forminator-field-text-18_69f332880c8bd\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-4\" class=\"forminator-field-checkbox forminator-col forminator-col-12 \"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-4-69f332880c8bd-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-4-69f332880c8bd-label\" class=\"forminator-label\">RSA-Citizen <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-checkbox-4-1-69f332880c8bd-label\" for=\"forminator-field-checkbox-4-1-69f332880c8bd\" class=\"forminator-checkbox\" title=\"Yes\"><input type=\"checkbox\" name=\"checkbox-4[]\" value=\"one\" id=\"forminator-field-checkbox-4-1-69f332880c8bd\" aria-labelledby=\"forminator-field-checkbox-4-1-69f332880c8bd-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Yes<\/span><\/label><label id=\"forminator-field-checkbox-4-2-69f332880c8bd-label\" for=\"forminator-field-checkbox-4-2-69f332880c8bd\" class=\"forminator-checkbox\" title=\"Other\"><input type=\"checkbox\" name=\"checkbox-4[]\" value=\"custom_option\" id=\"forminator-field-checkbox-4-2-69f332880c8bd\" aria-labelledby=\"forminator-field-checkbox-4-2-69f332880c8bd-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Other<\/span><\/label><div class=\"forminator-field forminator-custom-input\"><input id=\"custom-forminator-field-checkbox-4-2-69f332880c8bd\" name=\"custom-checkbox-4\" aria-labelledby=\"forminator-field-checkbox-4-2-69f332880c8bd-label\" class=\"forminator-input\" value=\"\" \/><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"date-2\" class=\"forminator-field-date forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-date-2-picker_69f332880c8bd\" id=\"forminator-field-date-2-picker_69f332880c8bd-label\" class=\"forminator-label\">Date of Birth <span class=\"forminator-required\">*<\/span><\/label><div class=\"forminator-input-with-icon\"><span class=\"forminator-icon-calendar\" aria-hidden=\"true\"><\/span><input autocomplete=\"off\" type=\"text\" size=\"1\" name=\"date-2\" value=\"\" placeholder=\"Leaner Birthday\" id=\"forminator-field-date-2-picker_69f332880c8bd\" class=\"forminator-input forminator-datepicker\" data-required=\"1\" data-format=\"dd-mm-yy\" data-restrict-type=\"\" data-restrict=\"\" data-start-year=\"2012\" data-end-year=\"2126\" data-past-dates=\"enable\" data-start-of-week=\"1\" data-start-date=\"01\/01\/2012\" data-end-date=\"\" data-start-field=\"\" data-end-field=\"\" data-start-offset=\"\" data-end-offset=\"\" data-disable-date=\"\" data-disable-range=\"01\/01\/2008 - 12\/31\/2011\" \/><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-17\" class=\"forminator-field-text forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-17_69f332880c8bd\" id=\"forminator-field-text-17_69f332880c8bd-label\" class=\"forminator-label\">Learner ID Number <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-17\" value=\"\" placeholder=\"Enter the learner ID Number\" id=\"forminator-field-text-17_69f332880c8bd\" class=\"forminator-input forminator-name--field\" data-required=\"1\" aria-describedby=\"forminator-field-text-17_69f332880c8bd-description\" \/><span id=\"forminator-field-text-17_69f332880c8bd-description\" class=\"forminator-description\">(or Passport Number if not SA citizen)<\/span><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-10\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-1743__field--select-10_69f332880c8bd\" id=\"forminator-form-1743__field--select-10_69f332880c8bd-label\" class=\"forminator-label\">Learner Gender <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-1743__field--select-10_69f332880c8bd\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-10\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Learner Gender\" data-search=\"false\" data-search-placeholder=\"Learner Gender\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-1743__field--select-10_69f332880c8bd-label\"><option value=\"\"  >Learner Gender<\/option><option value=\"one\"  data-calculation=\"0\">Male<\/option><option value=\"two\"  data-calculation=\"0\">Female<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-9\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-1743__field--select-9_69f332880c8bd\" id=\"forminator-form-1743__field--select-9_69f332880c8bd-label\" class=\"forminator-label\">Grade Applying For: <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-1743__field--select-9_69f332880c8bd\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-9\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Select the Grade Applying For\" data-search=\"false\" data-search-placeholder=\"Select the Grade Applying For\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-1743__field--select-9_69f332880c8bd-label\" aria-describedby=\"forminator-form-1743__field--select-9_69f332880c8bd-description\"><option value=\"\"  >Select the Grade Applying For<\/option><option value=\"one\"  data-calculation=\"0\">Grade RR<\/option><option value=\"two\"  data-calculation=\"0\">Grade 1<\/option><option value=\"Grade-2\"  data-calculation=\"0\">Grade 2<\/option><option value=\"Grade-3\"  data-calculation=\"0\">Grade 3<\/option><option value=\"Grade-4\"  data-calculation=\"0\">Grade 4<\/option><option value=\"Grade-5\"  data-calculation=\"0\">Grade 5<\/option><option value=\"Grade-6\"  data-calculation=\"0\">Grade 6<\/option><option value=\"Grade-7\"  data-calculation=\"0\">Grade 7<\/option><\/select><span id=\"forminator-form-1743__field--select-9_69f332880c8bd-description\" class=\"forminator-description\">Please use the grade you are applying for and not the current grade.<\/span><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-16\" class=\"forminator-field-text forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-16_69f332880c8bd\" id=\"forminator-field-text-16_69f332880c8bd-label\" class=\"forminator-label\">Current School <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-16\" value=\"\" placeholder=\"Enter the Learners current school\" id=\"forminator-field-text-16_69f332880c8bd\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-1\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-1743__field--select-1_69f332880c8bd\" id=\"forminator-form-1743__field--select-1_69f332880c8bd-label\" class=\"forminator-label\">Parent \/ Guardian (1) Relationship With Learner <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-1743__field--select-1_69f332880c8bd\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-1\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Select on of the following options\" data-search=\"false\" data-search-placeholder=\"Select on of the following options\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-1743__field--select-1_69f332880c8bd-label\"><option value=\"\"  >Select on of the following options<\/option><option value=\"one\"  data-calculation=\"0\">Parent<\/option><option value=\"two\"  data-calculation=\"0\">Guardian<\/option><option value=\"Proxy\"  data-calculation=\"0\">Proxy<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-13\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-1743__field--select-13_69f332880c8bd\" id=\"forminator-form-1743__field--select-13_69f332880c8bd-label\" class=\"forminator-label\">Parent \/ Guardian (2) Relationship With Learner<\/label><select  id=\"forminator-form-1743__field--select-13_69f332880c8bd\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"\" name=\"select-13\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Select on of the following options\" data-search=\"false\" data-search-placeholder=\"Select on of the following options\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-1743__field--select-13_69f332880c8bd-label\"><option value=\"\"  >Select on of the following options<\/option><option value=\"one\"  data-calculation=\"0\">Parent<\/option><option value=\"two\"  data-calculation=\"0\">Guardian<\/option><option value=\"Proxy\"  data-calculation=\"0\">Proxy<\/option><option value=\"N-A\"  data-calculation=\"0\">N\/A<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-23\" class=\"forminator-field-text forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-23_69f332880c8bd\" id=\"forminator-field-text-23_69f332880c8bd-label\" class=\"forminator-label\">Learner Age<\/label><input type=\"text\" name=\"text-23\" value=\"\" placeholder=\"Please enter the age of your child\" id=\"forminator-field-text-23_69f332880c8bd\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row forminator-action-buttons\"><div class=\"forminator-col forminator-col-12\"><input type=\"button\" value=\"Add Learner\" class=\"forminator-repeater-action-button forminator-repeater-add\" \/><input type=\"button\" value=\"Remove item\" class=\"forminator-repeater-action-button forminator-repeater-remove\" \/><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"group-1\" class=\"forminator-field-group forminator-col forminator-col-12 \"><label class=\"forminator-label forminator-repeater-label\">SECTION A.1: HOSTEL APPLICATION<\/label><span class=\"forminator-description forminator-repeater-description\">This form must be completed in full by the Parent, Guardian or Proxy.<\/span><div class=\"forminator-all-group-copies forminator-repeater-field\"><div class=\"forminator-grouped-fields\" data-options=\"{&quot;is_repeater&quot;:false,&quot;min_type&quot;:&quot;custom&quot;,&quot;max_type&quot;:&quot;custom&quot;,&quot;min&quot;:1,&quot;max&quot;:3,&quot;add_text&quot;:&quot;Add Learner&quot;,&quot;remove_text&quot;:&quot;Remove item&quot;,&quot;action_element_type&quot;:&quot;button&quot;}\"><div class=\"forminator-row\"><div id=\"checkbox-2\" class=\"forminator-field-checkbox forminator-col forminator-col-12 \"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-2-69f332880c8bd-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-2-69f332880c8bd-label\" class=\"forminator-label\">For Proxy Applicants: Has the parent or legal guardian authorized this application for hostel placement, and do they formally accept responsibility for the payment of all hostel fees in advance? <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-checkbox-2-1-69f332880c8bd-label\" for=\"forminator-field-checkbox-2-1-69f332880c8bd\" class=\"forminator-checkbox\" title=\"Yes\"><input type=\"checkbox\" name=\"checkbox-2[]\" value=\"one\" id=\"forminator-field-checkbox-2-1-69f332880c8bd\" aria-labelledby=\"forminator-field-checkbox-2-1-69f332880c8bd-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-checkbox-2-69f332880c8bd-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Yes<\/span><\/label><label id=\"forminator-field-checkbox-2-2-69f332880c8bd-label\" for=\"forminator-field-checkbox-2-2-69f332880c8bd\" class=\"forminator-checkbox\" title=\"No\"><input type=\"checkbox\" name=\"checkbox-2[]\" value=\"two\" id=\"forminator-field-checkbox-2-2-69f332880c8bd\" aria-labelledby=\"forminator-field-checkbox-2-2-69f332880c8bd-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-checkbox-2-69f332880c8bd-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">No<\/span><\/label><span id=\"forminator-field-checkbox-2-69f332880c8bd-description\" class=\"forminator-description\">The applicant is solely responsible for the payment of all hostel fees. Note: Hostel fees are separate from school fees; as such, payments must be made into their respective designated accounts.<\/span><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-8\" class=\"forminator-field-text forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-8_69f332880c8bd\" id=\"forminator-field-text-8_69f332880c8bd-label\" class=\"forminator-label\">Learner Full Name &amp; Surname <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-8\" value=\"\" placeholder=\"Enter the name of the child\" id=\"forminator-field-text-8_69f332880c8bd\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-1\" class=\"forminator-field-textarea forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-1_69f332880c8bd\" id=\"forminator-field-textarea-1_69f332880c8bd-label\" class=\"forminator-label\">Reason for Hostel Placement <span class=\"forminator-required\">*<\/span><\/label><textarea name=\"textarea-1\" placeholder=\"Example: Distance from home, transport issues, etc.\" id=\"forminator-field-textarea-1_69f332880c8bd\" class=\"forminator-textarea\" rows=\"6\" style=\"min-height:140px;\" >Example: Distance from home, transport issues, etc.<\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-14\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-1743__field--select-14_69f332880c8bd\" id=\"forminator-form-1743__field--select-14_69f332880c8bd-label\" class=\"forminator-label\">Disciplinary History <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-1743__field--select-14_69f332880c8bd\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-14\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Please select one of the following options\" data-search=\"false\" data-search-placeholder=\"Please select one of the following options\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-1743__field--select-14_69f332880c8bd-label\" aria-describedby=\"forminator-form-1743__field--select-14_69f332880c8bd-description\"><option value=\"\"  >Please select one of the following options<\/option><option value=\"one\"  data-calculation=\"0\">Yes<\/option><option value=\"two\"  data-calculation=\"0\">No<\/option><\/select><span id=\"forminator-form-1743__field--select-14_69f332880c8bd-description\" class=\"forminator-description\">Has the learner ever been subject to a formal disciplinary hearing at their current or previous school?<\/span><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-5\" class=\"forminator-field-textarea forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-5_69f332880c8bd\" id=\"forminator-field-textarea-5_69f332880c8bd-label\" class=\"forminator-label\">Please provide details on the Disciplinary History <span class=\"forminator-required\">*<\/span><\/label><textarea name=\"textarea-5\" placeholder=\"\" id=\"forminator-field-textarea-5_69f332880c8bd\" class=\"forminator-textarea\" rows=\"6\" style=\"min-height:140px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"section-8\" class=\"forminator-field-section forminator-col forminator-col-12 \"><div class=\"forminator-field\"><h2 class=\"forminator-title\">Medical Aid &amp; Dietary Information<\/h2><h3 class=\"forminator-subtitle\">Note: This section is vital for our hostel staff to ensure your child\u2019s safety and wellbeing. Please complete all fields; if a specific field does not apply to your child, please enter &quot;N\/A&quot;.<\/h3><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"consent-2\" class=\"forminator-field-consent forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-consent-2_69f332880c8bd\" id=\"forminator-field-consent-2_69f332880c8bd-label\" class=\"forminator-label\">Check if applicable<\/label><div class=\"forminator-checkbox__wrapper\"><label id=\"forminator-field-consent-2_69f332880c8bd__label\" class=\"forminator-checkbox forminator-consent\" aria-labelledby=\"forminator-field-consent-2_69f332880c8bd-label\"><input type=\"checkbox\" name=\"consent-2\" id=\"forminator-field-consent-2_69f332880c8bd\" value=\"checked\" aria-labelledby=\"forminator-field-consent-2_69f332880c8bd-label\" aria-describedby=\"forminator-field-consent-2_69f332880c8bd__description\" data-required=\"false\" aria-required=\"false\" \/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><\/label><div id=\"forminator-field-consent-2_69f332880c8bd__description\" class=\"forminator-checkbox__label forminator-consent__label\"><p>I do not have medical aid and authorise the school to seek state medical assistance in an emergency.<\/p><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-20\" class=\"forminator-field-text forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-20_69f332880c8bd\" id=\"forminator-field-text-20_69f332880c8bd-label\" class=\"forminator-label\">Medical Aid Name <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-20\" value=\"\" placeholder=\"Example: Discovery Medical Aid\" id=\"forminator-field-text-20_69f332880c8bd\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-19\" class=\"forminator-field-text forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-19_69f332880c8bd\" id=\"forminator-field-text-19_69f332880c8bd-label\" class=\"forminator-label\">Policy Number <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-19\" value=\"\" placeholder=\"Example: 12345678\" id=\"forminator-field-text-19_69f332880c8bd\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-21\" class=\"forminator-field-text forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-21_69f332880c8bd\" id=\"forminator-field-text-21_69f332880c8bd-label\" class=\"forminator-label\">Main Member Name <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-21\" value=\"\" placeholder=\"Full Names\" id=\"forminator-field-text-21_69f332880c8bd\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-5\" class=\"forminator-field-checkbox forminator-col forminator-col-12 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-5-69f332880c8bd-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-5-69f332880c8bd-label\" class=\"forminator-label\">No Family Doctor<\/span><label id=\"forminator-field-checkbox-5-1-69f332880c8bd-label\" for=\"forminator-field-checkbox-5-1-69f332880c8bd\" class=\"forminator-checkbox\" title=\"We do not have a Family Doctor\"><input type=\"checkbox\" name=\"checkbox-5[]\" value=\"one\" id=\"forminator-field-checkbox-5-1-69f332880c8bd\" aria-labelledby=\"forminator-field-checkbox-5-1-69f332880c8bd-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">We do not have a Family Doctor<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-22\" class=\"forminator-field-text forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-22_69f332880c8bd\" id=\"forminator-field-text-22_69f332880c8bd-label\" class=\"forminator-label\">Family Doctor <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-22\" value=\"\" placeholder=\"Ex Dr. John Doe\" id=\"forminator-field-text-22_69f332880c8bd\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"phone-6\" class=\"forminator-field-phone forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-phone-6_69f332880c8bd\" id=\"forminator-field-phone-6_69f332880c8bd-label\" class=\"forminator-label\">Family Doctor Number <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"phone-6\" value=\"\" placeholder=\"\" id=\"forminator-field-phone-6_69f332880c8bd\" class=\"forminator-input forminator-field--phone\" data-required=\"1\" aria-required=\"true\" autocomplete=\"off\" data-national_mode=\"enabled\" data-country=\"za\" data-validation=\"standard\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-2\" class=\"forminator-field-textarea forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-2_69f332880c8bd\" id=\"forminator-field-textarea-2_69f332880c8bd-label\" class=\"forminator-label\">Allergies <span class=\"forminator-required\">*<\/span><\/label><textarea name=\"textarea-2\" placeholder=\"Please list all allergies your child may have.\" id=\"forminator-field-textarea-2_69f332880c8bd\" class=\"forminator-textarea\" rows=\"6\" style=\"min-height:140px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-3\" class=\"forminator-field-textarea forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-3_69f332880c8bd\" id=\"forminator-field-textarea-3_69f332880c8bd-label\" class=\"forminator-label\">Chronic Medication <span class=\"forminator-required\">*<\/span><\/label><textarea name=\"textarea-3\" placeholder=\"\" id=\"forminator-field-textarea-3_69f332880c8bd\" class=\"forminator-textarea\" rows=\"6\" style=\"min-height:100px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-4\" class=\"forminator-field-textarea forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-4_69f332880c8bd\" id=\"forminator-field-textarea-4_69f332880c8bd-label\" class=\"forminator-label\">Special Dietary Requirements <span class=\"forminator-required\">*<\/span><\/label><textarea name=\"textarea-4\" placeholder=\"(e.g., No Pork, Vegetarian, Halaal)\" id=\"forminator-field-textarea-4_69f332880c8bd\" class=\"forminator-textarea\" rows=\"6\" style=\"min-height:140px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"consent-4\" class=\"forminator-field-consent forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-consent-4_69f332880c8bd\" id=\"forminator-field-consent-4_69f332880c8bd-label\" class=\"forminator-label\">Medical Cost Indemnity <span class=\"forminator-required\">*<\/span><\/label><div class=\"forminator-checkbox__wrapper\"><label id=\"forminator-field-consent-4_69f332880c8bd__label\" class=\"forminator-checkbox forminator-consent\" aria-labelledby=\"forminator-field-consent-4_69f332880c8bd-label\"><input type=\"checkbox\" name=\"consent-4\" id=\"forminator-field-consent-4_69f332880c8bd\" value=\"checked\" aria-labelledby=\"forminator-field-consent-4_69f332880c8bd-label\" aria-describedby=\"forminator-field-consent-4_69f332880c8bd__description\" data-required=\"true\" aria-required=\"true\" \/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><\/label><div id=\"forminator-field-consent-4_69f332880c8bd__description\" class=\"forminator-checkbox__label forminator-consent__label\"><p class=\"p1\">I take note that I will be responsible for all medical costs in an emergency or otherwise<\/p><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"section-9\" class=\"forminator-field-section forminator-col forminator-col-12 \"><div class=\"forminator-field\"><h2 class=\"forminator-title\">Weekend &amp; Travel Arrangements<\/h2><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-12\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-1743__field--select-12_69f332880c8bd\" id=\"forminator-form-1743__field--select-12_69f332880c8bd-label\" class=\"forminator-label\">Who will collect the learner on weekends? <span class=\"forminator-required\">*<\/span><\/label><select multiple id=\"forminator-form-1743__field--select-12_69f332880c8bd\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-12[]\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Please select a Parent \/ Guardian\" data-search=\"false\" data-search-placeholder=\"Search\" data-checkbox=\"false\" data-allow-clear=\"true\" aria-labelledby=\"forminator-form-1743__field--select-12_69f332880c8bd-label\"><option value=\"one\"  data-calculation=\"0\">Parent \/ Guardian 1<\/option><option value=\"two\"  data-calculation=\"0\">Parent \/ Guardian 2<\/option><option value=\"Authorized-Transport---Other:\"  data-calculation=\"0\">Authorized Transport<\/option><option value=\"custom_option\"  data-calculation=\"0\">Other  - Authorized Person's Contact Number:<\/option><\/select><div class=\"forminator-field forminator-custom-input\"><input id=\"custom-forminator-form-1743__field--select-12_69f332880c8bd\" name=\"custom-select-12\" class=\"forminator-input\" aria-label=\"Other  - Authorized Person&#039;s Contact Number:\" value=\"\" \/><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"section-10\" class=\"forminator-field-section forminator-col forminator-col-12 \"><div class=\"forminator-field\"><h2 class=\"forminator-title\">5. Financial Commitment &amp; Declaration<\/h2><h3 class=\"forminator-subtitle\">Since hostel fees are often separate from school fees, this part must be clear.<\/h3><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"html-3\" class=\"forminator-field-html forminator-col forminator-col-12 \"><div class=\"forminator-field forminator-merge-tags\" data-field=\"html-3\"><label class=\"forminator-label\">AGREEMENT OF RESPONSIBILITY<\/label><div style=\"font-family: 'Poppins', sans-serif;font-weight: 300;font-size: 14px;color: #374662;line-height: 1.6\">\n<ol>\n<li style=\"margin-bottom: 8px\">I understand that hostel fees are payable in advance.<\/li>\n<li style=\"margin-bottom: 8px\">I agree to abide by the Hostel Code of Conduct and Rules.<\/li>\n<li style=\"margin-bottom: 8px\">I acknowledge that the school\/hostel is not liable for the loss of personal property.<\/li>\n<li style=\"margin-bottom: 8px\">(For Proxies): I confirm that the legal parent\/guardian has authorized this placement and accepts financial responsibility.<\/li>\n<\/ol>\n<\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"consent-3\" class=\"forminator-field-consent forminator-col forminator-col-12 \"><div class=\"forminator-field\"><div class=\"forminator-checkbox__wrapper\"><label id=\"forminator-field-consent-3_69f332880c8bd__label\" class=\"forminator-checkbox forminator-consent\" aria-labelledby=\"forminator-field-consent-3_69f332880c8bd-label\"><input type=\"checkbox\" name=\"consent-3\" id=\"forminator-field-consent-3_69f332880c8bd\" value=\"checked\" aria-labelledby=\"forminator-field-consent-3_69f332880c8bd-label\" aria-describedby=\"forminator-field-consent-3_69f332880c8bd__description\" data-required=\"true\" aria-required=\"true\" \/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><\/label><div id=\"forminator-field-consent-3_69f332880c8bd__description\" class=\"forminator-checkbox__label forminator-consent__label\"><div style=\"font-family: 'Poppins', sans-serif;font-weight: 400;font-size: 16px;color: #374662;line-height: 1.6\">\n<p>I hereby acknowledge that I have read, understood, and agree to be bound by the terms and conditions set out in the Agreement of Responsibility.<\/p>\n<\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"section-1\" class=\"forminator-field-section forminator-col forminator-col-12 \"><div class=\"forminator-field\"><h2 class=\"forminator-title\">SECTION B: PARENT, GUARDIAN, OR PROXY DETAILS<\/h2><h3 class=\"forminator-subtitle\">N.B. This form must be completed in full by the Parent Guardian Proxy.<\/h3><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"group-3\" class=\"forminator-field-group forminator-col forminator-col-12 \"><label class=\"forminator-label forminator-repeater-label\">Personal Details Parent \/ Guardian One (1)<\/label><span class=\"forminator-description forminator-repeater-description\">This section refers to the first parent, legal guardian, or primary caregiver. This person will be the school\u2019s first point of contact.<\/span><div class=\"forminator-all-group-copies forminator-repeater-field\"><div class=\"forminator-grouped-fields\" data-options=\"{&quot;is_repeater&quot;:false,&quot;min_type&quot;:&quot;custom&quot;,&quot;max_type&quot;:&quot;custom&quot;,&quot;min&quot;:1,&quot;max&quot;:9223372036854775807,&quot;add_text&quot;:&quot;Add item&quot;,&quot;remove_text&quot;:&quot;Remove item&quot;,&quot;action_element_type&quot;:&quot;button&quot;}\"><div class=\"forminator-row\"><div id=\"name-2\" class=\"forminator-field-name forminator-col forminator-col-12 \"><div class=\"forminator-row forminator-no-margin\" data-multiple=\"true\"><div class=\"forminator-col forminator-col-md-6\"><div class=\"forminator-field\"><label for=\"forminator-field-1743__field--name-2_69f332880c8bd\" id=\"forminator-field-1743__field--name-2_69f332880c8bd-label\" class=\"forminator-label\">Prefix<\/label><select name=\"name-2-prefix\" id=\"forminator-field-1743__field--name-2_69f332880c8bd\" class=\"\" data-multi=\"1\" autocomplete=\"honorific-prefix\" aria-labelledby=\"forminator-field-1743__field--name-2_69f332880c8bd-label\" data-default-value=\"\"><option value=\"Mr\" >Mr.<\/option><option value=\"Mrs\" >Mrs.<\/option><option value=\"Ms\" >Ms.<\/option><option value=\"Mx\" >Mx.<\/option><option value=\"Miss\" >Miss<\/option><option value=\"Dr\" >Dr.<\/option><option value=\"Prof\" >Prof.<\/option><\/select><\/div><\/div><div class=\"forminator-col forminator-col-md-6\"><div class=\"forminator-field\"><label for=\"forminator-field-first-name-2_69f332880c8bd\" id=\"forminator-field-first-name-2_69f332880c8bd-label\" class=\"forminator-label\">First Name <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"name-2-first-name\" placeholder=\"\" id=\"forminator-field-first-name-2_69f332880c8bd\" class=\"forminator-input\" aria-required=\"true\" data-multi=\"1\" autocomplete=\"given-name\" value=\"\" \/><\/div><\/div><div class=\"forminator-col forminator-col-md-6\"><div class=\"forminator-field\"><label for=\"forminator-field-middle-name-2_69f332880c8bd\" id=\"forminator-field-middle-name-2_69f332880c8bd-label\" class=\"forminator-label\">Middle Name<\/label><input type=\"text\" name=\"name-2-middle-name\" placeholder=\"\" id=\"forminator-field-middle-name-2_69f332880c8bd\" class=\"forminator-input\" aria-required=\"false\" data-multi=\"1\" autocomplete=\"additional-name\" value=\"\" \/><\/div><\/div><div class=\"forminator-col forminator-col-md-6\"><div class=\"forminator-field\"><label for=\"forminator-field-last-name-2_69f332880c8bd\" id=\"forminator-field-last-name-2_69f332880c8bd-label\" class=\"forminator-label\">Last Name <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"name-2-last-name\" placeholder=\"\" id=\"forminator-field-last-name-2_69f332880c8bd\" class=\"forminator-input\" aria-required=\"true\" data-multi=\"1\" autocomplete=\"family-name\" value=\"\" \/><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-1\" class=\"forminator-field-checkbox forminator-col forminator-col-12 \"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-1-69f332880c8bd-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-1-69f332880c8bd-label\" class=\"forminator-label\">RSA-Citizen <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-checkbox-1-1-69f332880c8bd-label\" for=\"forminator-field-checkbox-1-1-69f332880c8bd\" class=\"forminator-checkbox\" title=\"Yes\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"one\" id=\"forminator-field-checkbox-1-1-69f332880c8bd\" aria-labelledby=\"forminator-field-checkbox-1-1-69f332880c8bd-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Yes<\/span><\/label><label id=\"forminator-field-checkbox-1-2-69f332880c8bd-label\" for=\"forminator-field-checkbox-1-2-69f332880c8bd\" class=\"forminator-checkbox\" title=\"Other\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"custom_option\" id=\"forminator-field-checkbox-1-2-69f332880c8bd\" aria-labelledby=\"forminator-field-checkbox-1-2-69f332880c8bd-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Other<\/span><\/label><div class=\"forminator-field forminator-custom-input\"><input id=\"custom-forminator-field-checkbox-1-2-69f332880c8bd\" name=\"custom-checkbox-1\" aria-labelledby=\"forminator-field-checkbox-1-2-69f332880c8bd-label\" class=\"forminator-input\" value=\"\" \/><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-15\" class=\"forminator-field-text forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-15_69f332880c8bd\" id=\"forminator-field-text-15_69f332880c8bd-label\" class=\"forminator-label\">Identity number of Parent\/Guardian 1 <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-15\" value=\"\" placeholder=\"Enter your ID number\" id=\"forminator-field-text-15_69f332880c8bd\" class=\"forminator-input forminator-name--field\" data-required=\"1\" maxlength=\"13\" \/><span id=\"forminator-field-text-15_69f332880c8bd-description\" class=\"forminator-description\"><span data-limit=\"13\" data-type=\"characters\">0 \/ 13<\/span><\/span><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"email-1\" class=\"forminator-field-email forminator-col forminator-col-12 \"><div class=\"forminator-row-inside forminator-row-with-confirmation-email\"><div class=\"forminator-col forminator-col-6\"><div class=\"forminator-field\"><label for=\"forminator-field-email-1_69f332880c8bd\" id=\"forminator-field-email-1_69f332880c8bd-label\" class=\"forminator-label\">Parent\/Guardian 1 Email Address <span class=\"forminator-required\">*<\/span><\/label><input type=\"email\" name=\"email-1\" value=\"\" placeholder=\"Please enter Parent\/Guardian 1email address\" id=\"forminator-field-email-1_69f332880c8bd\" class=\"forminator-input forminator-email--field\" data-required=\"1\" aria-required=\"true\" autocomplete=\"email\" \/><\/div><\/div><div class=\"forminator-col forminator-col-6\"><div class=\"forminator-field\"><label for=\"forminator-field-confirm_email-1_69f332880c8bd\" id=\"forminator-field-confirm_email-1_69f332880c8bd-label\" class=\"forminator-label\">Confirm Email Address <span class=\"forminator-required\">*<\/span><\/label><input type=\"email\" name=\"confirm_email-1\" value=\"\" placeholder=\"Re-type Email Address\" id=\"forminator-field-confirm_email-1_69f332880c8bd\" class=\"forminator-input forminator-name--field\" data-required=\"1\" aria-required=\"true\" autocomplete=\"email\" \/><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"phone-1\" class=\"forminator-field-phone forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-phone-1_69f332880c8bd\" id=\"forminator-field-phone-1_69f332880c8bd-label\" class=\"forminator-label\">Parent\/Guardian 1 Cell Number <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"phone-1\" value=\"\" placeholder=\"Enter Parent\/Guardian 1 Cell Number\" id=\"forminator-field-phone-1_69f332880c8bd\" class=\"forminator-input forminator-field--phone\" data-required=\"1\" aria-required=\"true\" autocomplete=\"off\" aria-describedby=\"forminator-field-phone-1_69f332880c8bd-description\" \/><span id=\"forminator-field-phone-1_69f332880c8bd-description\" class=\"forminator-description\" id=\"forminator-field-phone-1_69f332880c8bd-description\">This number will be used in case of an emergency.<\/span><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-6\" class=\"forminator-field-text forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-6_69f332880c8bd\" id=\"forminator-field-text-6_69f332880c8bd-label\" class=\"forminator-label\">Parent\/Guardian 1 Employer <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-6\" value=\"\" placeholder=\"Enter Parent\/Guardian 1 Employer\" id=\"forminator-field-text-6_69f332880c8bd\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-4\" class=\"forminator-field-text forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-4_69f332880c8bd\" id=\"forminator-field-text-4_69f332880c8bd-label\" class=\"forminator-label\">Parent\/Guardian 1 Occupation <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-4\" value=\"\" placeholder=\"Enter Parent\/Guardian 1 Occupation\" id=\"forminator-field-text-4_69f332880c8bd\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-3\" class=\"forminator-field-text forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-3_69f332880c8bd\" id=\"forminator-field-text-3_69f332880c8bd-label\" class=\"forminator-label\">Physical Business Address of Employer <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-3\" value=\"\" placeholder=\"Enter Physical Business Address of Employer\" id=\"forminator-field-text-3_69f332880c8bd\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"phone-4\" class=\"forminator-field-phone forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-phone-4_69f332880c8bd\" id=\"forminator-field-phone-4_69f332880c8bd-label\" class=\"forminator-label\">Parent\/Guardian 1 Employer Number <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"phone-4\" value=\"\" placeholder=\"Enter Parent\/Guardian 1 Employer Number\" id=\"forminator-field-phone-4_69f332880c8bd\" class=\"forminator-input forminator-field--phone\" data-required=\"1\" aria-required=\"true\" autocomplete=\"off\" \/><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"group-2\" class=\"forminator-field-group forminator-col forminator-col-12 \"><label class=\"forminator-label forminator-repeater-label\">Personal Details Parent \/ Guardian Two (2)<\/label><div class=\"forminator-all-group-copies forminator-repeater-field\"><div class=\"forminator-grouped-fields\" data-options=\"{&quot;is_repeater&quot;:false,&quot;min_type&quot;:&quot;custom&quot;,&quot;max_type&quot;:&quot;custom&quot;,&quot;min&quot;:1,&quot;max&quot;:9223372036854775807,&quot;add_text&quot;:&quot;Add item&quot;,&quot;remove_text&quot;:&quot;Remove item&quot;,&quot;action_element_type&quot;:&quot;button&quot;}\"><div class=\"forminator-row\"><div id=\"name-3\" class=\"forminator-field-name forminator-col forminator-col-12 \"><div class=\"forminator-row forminator-no-margin\" data-multiple=\"true\"><div class=\"forminator-col forminator-col-md-6\"><div class=\"forminator-field\"><label for=\"forminator-field-1743__field--name-3_69f332880c8bd\" id=\"forminator-field-1743__field--name-3_69f332880c8bd-label\" class=\"forminator-label\">Prefix<\/label><select name=\"name-3-prefix\" id=\"forminator-field-1743__field--name-3_69f332880c8bd\" class=\"\" data-multi=\"1\" autocomplete=\"honorific-prefix\" aria-labelledby=\"forminator-field-1743__field--name-3_69f332880c8bd-label\" data-default-value=\"\"><option value=\"Mr\" >Mr.<\/option><option value=\"Mrs\" >Mrs.<\/option><option value=\"Ms\" >Ms.<\/option><option value=\"Mx\" >Mx.<\/option><option value=\"Miss\" >Miss<\/option><option value=\"Dr\" >Dr.<\/option><option value=\"Prof\" >Prof.<\/option><\/select><\/div><\/div><div class=\"forminator-col forminator-col-md-6\"><div class=\"forminator-field\"><label for=\"forminator-field-first-name-3_69f332880c8bd\" id=\"forminator-field-first-name-3_69f332880c8bd-label\" class=\"forminator-label\">First Name<\/label><input type=\"text\" name=\"name-3-first-name\" placeholder=\"\" id=\"forminator-field-first-name-3_69f332880c8bd\" class=\"forminator-input\" aria-required=\"false\" data-multi=\"1\" autocomplete=\"given-name\" value=\"\" \/><\/div><\/div><div class=\"forminator-col forminator-col-md-6\"><div class=\"forminator-field\"><label for=\"forminator-field-middle-name-3_69f332880c8bd\" id=\"forminator-field-middle-name-3_69f332880c8bd-label\" class=\"forminator-label\">Middle Name<\/label><input type=\"text\" name=\"name-3-middle-name\" placeholder=\"\" id=\"forminator-field-middle-name-3_69f332880c8bd\" class=\"forminator-input\" aria-required=\"false\" data-multi=\"1\" autocomplete=\"additional-name\" value=\"\" \/><\/div><\/div><div class=\"forminator-col forminator-col-md-6\"><div class=\"forminator-field\"><label for=\"forminator-field-last-name-3_69f332880c8bd\" id=\"forminator-field-last-name-3_69f332880c8bd-label\" class=\"forminator-label\">Last Name<\/label><input type=\"text\" name=\"name-3-last-name\" placeholder=\"\" id=\"forminator-field-last-name-3_69f332880c8bd\" class=\"forminator-input\" aria-required=\"false\" data-multi=\"1\" autocomplete=\"family-name\" value=\"\" \/><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-3\" class=\"forminator-field-checkbox forminator-col forminator-col-12 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-3-69f332880c8bd-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-3-69f332880c8bd-label\" class=\"forminator-label\">RSA-Citizen<\/span><label id=\"forminator-field-checkbox-3-1-69f332880c8bd-label\" for=\"forminator-field-checkbox-3-1-69f332880c8bd\" class=\"forminator-checkbox\" title=\"Yes\"><input type=\"checkbox\" name=\"checkbox-3[]\" value=\"one\" id=\"forminator-field-checkbox-3-1-69f332880c8bd\" aria-labelledby=\"forminator-field-checkbox-3-1-69f332880c8bd-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Yes<\/span><\/label><label id=\"forminator-field-checkbox-3-2-69f332880c8bd-label\" for=\"forminator-field-checkbox-3-2-69f332880c8bd\" class=\"forminator-checkbox\" title=\"Other\"><input type=\"checkbox\" name=\"checkbox-3[]\" value=\"custom_option\" id=\"forminator-field-checkbox-3-2-69f332880c8bd\" aria-labelledby=\"forminator-field-checkbox-3-2-69f332880c8bd-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Other<\/span><\/label><div class=\"forminator-field forminator-custom-input\"><input id=\"custom-forminator-field-checkbox-3-2-69f332880c8bd\" name=\"custom-checkbox-3\" aria-labelledby=\"forminator-field-checkbox-3-2-69f332880c8bd-label\" class=\"forminator-input\" value=\"\" \/><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-14\" class=\"forminator-field-text forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-14_69f332880c8bd\" id=\"forminator-field-text-14_69f332880c8bd-label\" class=\"forminator-label\">Identity number of Parent\/Guardian 2<\/label><input type=\"text\" name=\"text-14\" value=\"\" placeholder=\"Enter your ID number\" id=\"forminator-field-text-14_69f332880c8bd\" class=\"forminator-input forminator-name--field\" data-required=\"\" maxlength=\"13\" \/><span id=\"forminator-field-text-14_69f332880c8bd-description\" class=\"forminator-description\"><span data-limit=\"13\" data-type=\"characters\">0 \/ 13<\/span><\/span><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"phone-2\" class=\"forminator-field-phone forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-phone-2_69f332880c8bd\" id=\"forminator-field-phone-2_69f332880c8bd-label\" class=\"forminator-label\">Parent\/Guardian 2 Cell Number<\/label><input type=\"text\" name=\"phone-2\" value=\"\" placeholder=\"Enter Parent\/Guardian 1 Cell Number\" id=\"forminator-field-phone-2_69f332880c8bd\" class=\"forminator-input forminator-field--phone\" data-required=\"\" aria-required=\"false\" autocomplete=\"off\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"email-2\" class=\"forminator-field-email forminator-col forminator-col-12 \"><div class=\"forminator-row-inside forminator-row-with-confirmation-email\"><div class=\"forminator-col forminator-col-6\"><div class=\"forminator-field\"><label for=\"forminator-field-email-2_69f332880c8bd\" id=\"forminator-field-email-2_69f332880c8bd-label\" class=\"forminator-label\">Parent\/Guardian 2 Email Address<\/label><input type=\"email\" name=\"email-2\" value=\"\" placeholder=\"Enter Parent\/Guardian 2 Email Address\" id=\"forminator-field-email-2_69f332880c8bd\" class=\"forminator-input forminator-email--field\" data-required=\"\" aria-required=\"false\" autocomplete=\"email\" \/><\/div><\/div><div class=\"forminator-col forminator-col-6\"><div class=\"forminator-field\"><label for=\"forminator-field-confirm_email-2_69f332880c8bd\" id=\"forminator-field-confirm_email-2_69f332880c8bd-label\" class=\"forminator-label\">Confirm Email Address<\/label><input type=\"email\" name=\"confirm_email-2\" value=\"\" placeholder=\"Re-type Email Address\" id=\"forminator-field-confirm_email-2_69f332880c8bd\" class=\"forminator-input forminator-name--field\" data-required=\"\" aria-required=\"false\" autocomplete=\"email\" \/><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-5\" class=\"forminator-field-text forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-5_69f332880c8bd\" id=\"forminator-field-text-5_69f332880c8bd-label\" class=\"forminator-label\">Parent\/Guardian 2 Occupation<\/label><input type=\"text\" name=\"text-5\" value=\"\" placeholder=\"Enter Parent\/Guardian 2 Occupation\" id=\"forminator-field-text-5_69f332880c8bd\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-7\" class=\"forminator-field-text forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-7_69f332880c8bd\" id=\"forminator-field-text-7_69f332880c8bd-label\" class=\"forminator-label\">Parent\/Guardian 2 Employer<\/label><input type=\"text\" name=\"text-7\" value=\"\" placeholder=\"Enter Parent\/Guardian 2 Employer\" id=\"forminator-field-text-7_69f332880c8bd\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"phone-5\" class=\"forminator-field-phone forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-phone-5_69f332880c8bd\" id=\"forminator-field-phone-5_69f332880c8bd-label\" class=\"forminator-label\">Parent\/Guardian 2 Employer Number<\/label><input type=\"text\" name=\"phone-5\" value=\"\" placeholder=\"Enter Parent\/Guardian 1 Employer Number\" id=\"forminator-field-phone-5_69f332880c8bd\" class=\"forminator-input forminator-field--phone\" data-required=\"\" aria-required=\"false\" autocomplete=\"off\" data-national_mode=\"enabled\" data-country=\"za\" data-validation=\"standard\" \/><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"section-3\" class=\"forminator-field-section forminator-col forminator-col-12 \"><div class=\"forminator-field\"><h2 class=\"forminator-title\">Document Upload<\/h2><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"upload-1\" class=\"forminator-field-upload forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-upload-1_69f332880c8bd\" id=\"forminator-field-upload-1_69f332880c8bd-label\" class=\"forminator-label\">Please upload the following documents to proceed: <span class=\"forminator-required\">*<\/span><\/label><div class=\"forminator-multi-upload \" data-element=\"upload-1_69f332880c8bd\" aria-describedby=\"forminator-field-upload-1_69f332880c8bd-description\"><input type=\"file\" name=\"upload-1[]\" id=\"forminator-field-upload-1_69f332880c8bd\" class=\"forminator-input-file-required do-validate forminator-field-upload-1_69f332880c8bd-1743\" multiple=\"multiple\" data-method=\"ajax\" accept=\".avif,.heif,.heics,.heifs,.svgz,.docx,.pdf\" data-size=\"8000000\" data-size-message=\"Maximum file size allowed is 8 MB. \" data-filetype=\"avif|heif|heics|heifs|svgz|docx|pdf\" data-filetype-message=\"file extension is not allowed.\"><div class=\"forminator-multi-upload-message\" aria-hidden=\"true\"><span class=\"forminator-icon-upload\" aria-hidden=\"true\"><\/span><p>Drag and Drop (or) <a class=\"forminator-upload-file--forminator-field-upload-1_69f332880c8bd\" href=\"#\" onclick=\"return false;\">Choose Files<\/a><\/p><\/div><\/div><span id=\"forminator-field-upload-1_69f332880c8bd-description\" class=\"forminator-description\">Learner Documents: Birth Certificate and latest Report Card.  Identification: Parent\/Guardian ID. (Please include Proof of Guardianship if applicable).  Proof of Residence: * Homeowners: Municipal account (&lt; 3 months old).  Tenants: Signed lease agreement + landlord\u2019s ID and municipal account.  Proof of Work Address: Recent payslip or stamped employer letter.  Privacy Note: We are committed to protecting your family&#039;s privacy. These documents are collected solely for registration and will be handled with strict confidentiality.  Note: If further documentation is needed, our office will contact you.<\/span><ul class=\"forminator-uploaded-files upload-container-upload-1_69f332880c8bd\"><\/ul><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"html-1\" class=\"forminator-field-html forminator-col forminator-col-12 \"><div class=\"forminator-field forminator-merge-tags\" data-field=\"html-1\"><label class=\"forminator-label\">UNDERTAKING BY PARENTS \/ GUARDIAN \/ PROXY<\/label><p class=\"p1\"><strong>TRANSPORT<\/strong><\/p>\n<p class=\"p3\">1. I am aware that the hostel is <b>closed <\/b>during the <b>school holidays<\/b> and <b>on weekends<\/b>, and that it is my&nbsp;responsibility to provide transport for my child to and from the hostel at my own expense. I am also aware that children must be fetched latest at 18:00 on a Friday.<\/p>\n<p class=\"p3\">2. I undertake to notify the responsible officer immediately of any change in address, telephone&nbsp;numbers etc. I undertake to abide by the rules and regulations. I undertake not to sue the school&nbsp;hostel or staff for any damages should my child\/ren by injured in sport or in extramural activities to&nbsp;which I consented, or any transport where school activities are involved.<\/p><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"html-2\" class=\"forminator-field-html forminator-col forminator-col-12 \"><div class=\"forminator-field forminator-merge-tags\" data-field=\"html-2\"><label class=\"forminator-label\">UNDERTAKING BY PARENTS \/ GUARDIAN \/ PROXY<\/label><p class=\"p2\"><span class=\"s1\">1. <\/span><b>Hostel regulations and rules<\/b><span class=\"s1\">:<\/span><\/p>\n<p class=\"p3\">I am aware that my child\u2019s admission is subject to hostel regulations, as well as the rules of the&nbsp;hostel.<\/p>\n<p class=\"p3\">I am prepared to comply with the above and undertake to :&nbsp;<\/p>\n<p class=\"p3\">a) Pay the boarding fees regularly and in advance every month before the 7th.<\/p>\n<p class=\"p3\">b) Give a full MONTH\u2019S notice before I remove my child from the hostel;<\/p>\n<p class=\"p3\">c) Compensate \/ Pay for, any damages caused by my child, whatever it may be.<\/p>\n<p class=\"p1\"><strong>TRANSPORT<\/strong><\/p>\n<p class=\"p3\">1. I am aware that the hostel is <b>closed <\/b>during the <b>school holidays<\/b> and <b>on weekends<\/b>, and that it is my<\/p>\n<p class=\"p3\">responsibility to provide transport for my child to and from the hostel at my own expense. I am also<\/p>\n<p class=\"p3\">aware that children must be fetched latest at 18:00 on a Friday.<\/p>\n<p class=\"p3\">2. I undertake to notify the responsible officer immediately of any change in address, telephone<\/p>\n<p class=\"p3\">numbers etc. I undertake to abide by the rules and regulations. I undertake not to sue the school<\/p>\n<p class=\"p3\">hostel or staff for any damages should my child\/ren by injured in sport or in extramural activities to<\/p>\n<p class=\"p3\">which I consented, or any transport where school activities are involved.<\/p><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"consent-1\" class=\"forminator-field-consent forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-consent-1_69f332880c8bd\" id=\"forminator-field-consent-1_69f332880c8bd-label\" class=\"forminator-label\">Consent <span class=\"forminator-required\">*<\/span><\/label><div class=\"forminator-checkbox__wrapper\"><label id=\"forminator-field-consent-1_69f332880c8bd__label\" class=\"forminator-checkbox forminator-consent\" aria-labelledby=\"forminator-field-consent-1_69f332880c8bd-label\"><input type=\"checkbox\" name=\"consent-1\" id=\"forminator-field-consent-1_69f332880c8bd\" value=\"checked\" aria-labelledby=\"forminator-field-consent-1_69f332880c8bd-label\" aria-describedby=\"forminator-field-consent-1_69f332880c8bd__description\" data-required=\"true\" aria-required=\"true\" \/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><\/label><div id=\"forminator-field-consent-1_69f332880c8bd__description\" class=\"forminator-checkbox__label forminator-consent__label\">Yes, I agree with the <a href=\"https:\/\/lsbekker.co.za\/?elementor_library=default-kit-3\" target=\"_blank\">privacy policy<\/a> and <a href=\"#\" target=\"_blank\">terms and conditions<\/a>.<\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"captcha-1\" class=\"forminator-field-captcha forminator-col forminator-col-12 \"><div class=\"forminator-captcha-left forminator-g-recaptcha\" data-theme=\"light\"  data-sitekey=\"6LcGQWssAAAAAKoiFoKRJgsqdXIMLnAFN2BW2whL\" data-size=\"normal\"><\/div> <\/div><\/div><input type=\"hidden\" name=\"referer_url\" value=\"\" \/><div class=\"forminator-row forminator-row-last\"><div class=\"forminator-col\"><div class=\"forminator-field\"><button class=\"forminator-button forminator-button-submit\">Submit<\/button><\/div><\/div><\/div><input type=\"hidden\" id=\"forminator_nonce\" name=\"forminator_nonce\" value=\"40fbced4d2\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/index.php\/wp-json\/wp\/v2\/pages\/1988\" \/><input type=\"hidden\" name=\"form_id\" value=\"1743\"><input type=\"hidden\" name=\"page_id\" value=\"1988\"><input type=\"hidden\" name=\"form_type\" value=\"default\"><input type=\"hidden\" name=\"current_url\" value=\"https:\/\/lsbekker.co.za\/index.php\/learskool-bekker-application-form\/\"><input type=\"hidden\" name=\"render_id\" value=\"0\"><input type=\"hidden\" name=\"forminator-multifile-hidden\" class=\"forminator-multifile-hidden\"><input type=\"hidden\" name=\"action\" value=\"forminator_submit_form_custom-forms\"><\/form>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"","protected":false},"author":3,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"inline_featured_image":false,"_kad_post_transparent":"","_kad_post_title":"hide","_kad_post_layout":"fullwidth","_kad_post_sidebar_id":"","_kad_post_content_style":"unboxed","_kad_post_vertical_padding":"hide","_kad_post_feature":"hide","_kad_post_feature_position":"","_kad_post_header":false,"_kad_post_footer":false,"_kad_post_classname":"","footnotes":""},"class_list":["post-1988","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/lsbekker.co.za\/index.php\/wp-json\/wp\/v2\/pages\/1988","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/lsbekker.co.za\/index.php\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/lsbekker.co.za\/index.php\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/lsbekker.co.za\/index.php\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/lsbekker.co.za\/index.php\/wp-json\/wp\/v2\/comments?post=1988"}],"version-history":[{"count":6,"href":"https:\/\/lsbekker.co.za\/index.php\/wp-json\/wp\/v2\/pages\/1988\/revisions"}],"predecessor-version":[{"id":1994,"href":"https:\/\/lsbekker.co.za\/index.php\/wp-json\/wp\/v2\/pages\/1988\/revisions\/1994"}],"wp:attachment":[{"href":"https:\/\/lsbekker.co.za\/index.php\/wp-json\/wp\/v2\/media?parent=1988"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}