Form 16 Application For The Registration/ Conditional Registration/ Renewal Of Registration Of An Early Childhood Development Programme (Page 2 of 3) in pdf

Form 16 Application For The Registration/ Conditional Registration/ Renewal Of Registration Of An Early Childhood Development Programme Page 2

Name

the

Position

ID Number

Gender

Qualifications/Other

Date

Practitioner

Certificates

appointment/

Experience



In the case of a partial care or child youth care centre, the relevant registration as a partial care or child

and youth care centre;



a clearance certificate that the name of the applicant does not appear in the National Register for Sex

Offenders established by Chapter 6 of the Criminal Law (Sexual Offences and Related Matters)

Amendment Act 32 0f 2007 or in Part B of the National Child Protection Register established by Part 2

of Chapter 7 of the Act.

(D)

GENERAL REMARKS

Any additional remarks by the applicant in support of the application: ________________________

________________________________________________________________________________

I certify that the above-mentioned particulars are, to the best of my knowledge, true and correct.

____________________________

_________________________

_______________

SIGNATURE OF APPLICANT

CAPACITY

DATE

Form 16 Application For The Registration/ Conditional Registration/ Renewal Of Registration Of An Early Childhood Development Programme Page 2