Form 11, Application For Registration, Conditional Registration, Renewal Of Registration printable pdf download

Form 11, Application For Registration, Conditional Registration, Renewal Of Registration

FORM 11

APPLICATION FOR THE REGISTRATION / CONDITIONAL REGISTRATION /

RENEWAL OF REGISTRATION / REINSTATEMENT OF A PARTIAL CARE FACILITY

(* DELETE WHICH IS NOT APPLICABLE)

(Regulation 14)

[SECTION 81 OTHE CHILDREN’S ACT 38 OF 2005]

(A)

NATURE OF APPLICATION

This is an application in respect of:

A crèche, providing partial care for children from birth to an age of 3 years

An educare centre, providing partial care for children from 3 years until school going age

An after school centre, providing partial care for children attending a primary or secondary school

A private hostel, providing partial care for children attending a primary or secondary school

A temporary respite care facility, providing temporary full-time partial care during the temporary

absence of their parents or a parent or care-giver of a child

A place of care providing partial care for children with disabilities who require a high level of support

(Indicate the partial care facility or facilities in respect of which application is made)

(B)

PARTICULARS OF APPLICATION

Name of partial care facility: _____________________________________________________

Physical address:______________________________________________________________

____________________________________________________________________________

Postal address: _______________________________________________________________

___________________________________________________ Postal code: ______________

Name of person or body who manages the partial care facility or who wishes to establish it:

_____________________________________________________________________________

Physical address of person or body: _______________________________________________

_____________________________________________________________________________

Telephone : _________________________ Cell phone: _______________________________

Fax number: _________________________ E-mail: ___________________________________

The number of children that will be accommodated in each category of partial care in respect of which application

is made: ________________________________________________________________

_________________________________________________________________________________

Form 11, Application For Registration, Conditional Registration, Renewal Of Registration