Application for Learner Registration

Avicci Academy Registration Application

Application to Register New Learner

This form is for parents or guardians to register new learners on the Avicci Academy learning system. Parents and Guardians are also registered, so they can track progress of their children.

Details of Parents and/or Guardians

enter parent's details here - to register both parents, choose Yes below

Do you want to add both parents?

Yes

First Name

Last Name/Surname

Email Address

Parent/Guardian Telephone Number

South African ID Number

Address Line 1

Address Line 2

City

Province

Post Code

Country

Second Parent Details

First Name

Last Name/Surname

Email Address

Parent/Guardian Telephone Number

South African ID Number

Address Line 1

Address Line 2

City

Province

Post Code

Country

Details for First Learner

enter the learner details here - up to three children can be added
to add another select the checkbox at the end of this section

First Name

Last Name/Surname

Date of Birth

Learner - Gender

South African ID Number

Home Language

Second Language

Grade Year to Join

Anticipated Start Date

Add Another Learner?

Yes, add another

Details for Second Learner

First Name

Last Name/Surname

Date of Birth

Learner - Gender

South African ID Number

Home Language

Second Language

Grade Year to Join

Anticipated Start Date

Add Another Learner?

Yes, add another

Details for Third Learner

First Name

Last Name/Surname

Date of Birth

Learner - Gender

South African ID Number

Home Language

Second Language

Grade Year to Join

Anticipated Start Date

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I consent to having this website store my submitted information so they can respond to my inquiry