86 Siddle St, Neserhof, Klerksdorp CBD, 2750
info@barbieandben.co.za
018 462 0195/ 081 384 1069
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Online Application
Barbie & Ben Preschool
Online Application Form
Complete the form below to apply for admission.
Parent / Guardian Information
Full Name
Email Address
Phone Number
Relationship to Child
Select
Mother
Father
Guardian
Other
Child Information
Child's Full Name
Date of Birth
Gender
Select Gender
Male
Female
Applying For
Select Class
Tiger Class(6 months – 2 years
Dolphins Class(2 – 3 years)
Seals Class(3 – 4 years)
Elephants Class(4 – 5 years)
Residential Address
Medical Information
Medical Conditions / Allergies
Emergency Contact Number
Additional Information
Additional Notes
Declaration
I declare that the information provided in this application is true and correct.
Parent / Guardian Signature (Type Full Name)
Application Date
Submit Application
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