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Mindscape Education (Pty) Ltd Olivedale Business Park  

35 Lima Rd, Olivedale  2188 

www.mindscapeeducation.co.za   

Registration: 2015/03508/087 

GRADE R to GRADE 9 REGISTRATION FORM ‐ 2022 

Thank you for choosing Mindscape Education as your preferred curriculum provider.

 Kindly complete the document as follows – Incomplete applications will not be processed.

Once this application document has been completed, please email your application and supporting documents to 

registration@mindscapeeducation.co.za 

Document Checklist 

⃣⃣⃣⃣⃣⃣⃣

⃣

Complete and signed registration forms. Copy of the Parent's/Guardian's ID (first time applicants only). Copy of the Account Holder's ID (if different from Parent/Guardian). Copy of the Child's Birth Certificate or ID (first time applicants only). Most recent report showing progression to the next grade (Term 3 reports will not be accepted)

Once you have received an invoice, kindly make payment to the bank details stipulated on your invoice and use the learners Name and Surname or the account number as a reference. Proof of payments can be emailed to accounts@mindscapeeducation.co.za

Use Black Ink Only

•Sign the document in full on the lastpage

Initial All 

Pages

Mindscape Curriculum 

box is dispatched. 

Deposit or full payment is 

made to Mindscape 

Application is processed 

and  invoiceis issued 

Scan and email or 

complete on online 

Complete application and attach supporting documents 

REGISTRATION FORM - 2022PLEASE COMPLETE WITH A BLACK PENDO YOU HAVE ANY LEARNERS CURRENTLY REGISTERED WITH MINDSCAPE? Yes No

Parent to Student : Yes / No Tutor to Student : Yes / No

LEARNER INFORMATIONLEARNER INFORMATIONLEARNER

Full names:

Surname:

Preferred name:

Date of birth:

ID number:

Nationality: RSA Other

Religious denomination:

Gender: Male Female

Ethnic group:

Home language:

Learner's language preference:

Learner mobile number:

Learner e-mail address:

Admission date:

Grade in 2022 :

Years in grade for 2022 :

Years in phase for 2022 :

Pre-primary education attended: Formal Informal

Other: _____________

Attach learner photo:

Method of transport:

Taxi/Bus registration number:

Name of driver:

Contact number:

NEXT OF KIN INFORMATION

Name:

Contact number:

Alternative contact number:

Relation:

OFFICE USE ONLY

Family code:

Register class:

SBA Venue:

Waiting list: A B

Number on waiting list:

Parent ID copy: Deposit fee: Most recent report: Birth certificate / ID:

FAMILY INFORMATION

Family status: Both parents Single parent - Unmarried

Foster care Childrens home Single parent - Divorced

Other Re-composed Widow/Widower

Parents deceased: Mother Father None

LEARNER HEALTH INFORMATION

Chronic diseases

or allergies :

Concession App:

MEDICAL AID INFORMATION

Name:

Telephone number:

Member number:

Primary member:

FAMILY DOCTOR INFORMATION

Name:

Telephone number:

Business address:

INFORMATION OF PREVIOUS SCHOOL/PLAY GROUP/NURSERY

First registration of learner in Gauteng: Yes No

Learner attended school last year Yes No

If yes, in which Province/Country:

Previous school

Telephone Number

Address

Province

Highest grade in previous school

Reason for leaving the school

(ddmmyyyy)

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BIOLOGICAL PARENT / LEGAL GUARDIAN 1 INFORMATION

SMS E-mail

Title:

Full names:

Surname:

Initials:

Preferred name:

ID number:

Home language:

Communication preference:

Language preference: N/A

Mobile number:

Home tel:

Fax:

E-mail:

Residential address:

Postal address:

Occupation status: Own Employer Professional

Own Employer Non-Professional

House wife Part time

Contract worker Pensioner

Student Temporary

Full time Unemployed

Occupation:

Employer:

Work telephone number:

Employer physical address:

Is the learner living with this parent? Yes No

BIOLOGICAL PARENT / LEGAL GUARDIAN 2 INFORMATION

Title:

Full names:

Surname:

Initials:

Preferred name:

ID number:

Home language:

Communication preference: SMS E-mail

Language preference:

Mobile number:

Home tel:

Fax:

E-mail:

Residential address:

Postal address:

Occupation status: Own Employer Professional

Own Employer Non-Professional

House wife Part time

Contract worker Pensioner

Student Temporary

Full time Unemployed

Occupation:

Employer:

Work telephone number:

Employer physical address:

Is the learner living with this parent? Yes No

ACCOUNTABLE PERSONS INFORMATIONORMATIONATION

BIOLOGICAL PARENT 1 YES / NO

BIOLOGICAL PARENT 2 YES / NO

IF OTHER, PLEASE PROVIDE DETAILS : _________________________________________________________________________

Date of birth: (ddmmyyyy) ____________________________________

Date of birth: (ddmmyyyy) ____________________________________

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N/A

2022 PAYMENT OPTIONS - Select by tick

HADEDA Early Bird Promotion! valid until 30 November 2021. Payment in full to qualify for 2021 fees.

Option 1 Full Annual Fee upfront payment @ 7.5% discount - valid until 31 January 2022

Option 2 40% Deposit on registration and balance paid over 4 termly invoices payable by EFT.

**Termly payment dates : 12 Jan , 5 April, 19 July and 11 October

Option 3 40% Deposit on registration and balance paid over 10 monthly debit orders.

**Monthly payment dates : 1 February, 1 March,1 April, 1 May, 1 June, 1 July, 1 August, 1 September, 1 October, 1 November

• No Cheques or Cash accepted. Cash paid into the Mindscape Education's account will carry a surcharge• Payments to be paid directly to Mindscape Education and no other third party• Student’s Name and Surname or Invoice number must be used as reference on all payments.• Statements are available via the D6 Connect app. Please download this from the App store or Google Play• Fees quoted are inclusive of VAT.• Debit order forms must accompany the registration form where applicable• Grade 12 Fees include the SACAI National Senior Certificate Exam Fee.• Deposit is payable within 7 days of receipt of invoice• Cancelled or Returned Debit Orders will incur a R250 penalty fee per transaction• Termly fees are billed per term in advance• Excludes: Courier costs• Excludes: Grade 12 Practical Fees• Excludes: Grade 12 NSC venue hosting fee – where the candidate will be hosted for Final exams.

PAYMENT METHODS Deposit payable upfront in full upon approval of enrolment by EFT Termly payments via EFT in advance Monthly payments via Debit Order in advance and only subject to approval

I acknowledge and understand the fee structure and payment terms and that a deposit is required if I have chosen the payment plan of Option 2 or 3.

In the event that I need clarification on the fee structure I will contact Mindscape Education directly on 011 704 0687 or email accounts@mindscapeeducation.co.za

South African Comprehensive Assessment Institute (SACAI) fees are subject to change.*R7920 - SACAI National Senior Certificate Fee, is included in the 2022 fees**R4200 - SACAI Learner Placement fee, is not included above, payable to SACAI in August for venue

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Who will be responsible for the learners daily tuition?

Pare

nt

to s

tud

en

t • Parent accepts fullresponsibility forchild's education

and facilitatesMindscape Curriculum

Tuto

r to

Stu

de

nt o SBA Venue

o Tutoro Independent School

Name of Tutor/Institution

_____________________ _____________________ _____________________ _____________________

School-in-a-Box Delivery Method – please select

Maths Buddy Annual License Mindscape recommends the use of Maths Buddy as an added maths resource to supplement day to day teaching. It allows a learner to use the program at home and to revise on topics covered in class and incorporates fun online tests for practice and revision. Please note a tablet / computer and internet is required to run the program.

Features over 1 800 animated and narrated (full audio-visual) maths lessons and more than 65 000 interactive questions. Content reflects CAPS curriculumIncludes Advanced Programme Maths (AP Maths)

One licence gives you access to content and worksheets from Grade R to Grade

12 ADD R450 to my account for my child’s annual Maths Buddy license for 2022

Please note the Maths Buddy program is only available in English and is not for Maths Literacy learners.

SBA Venue delivery - a once-off annual fee of R350, payable upon registration

Home Delivery - a once-off annual fee of R450, outlying areas may incur additional fees

Collection of your curriculum box from Mindscape H/O in Randburg upon notification.

Maths Buddy Annual License

Subject Based Assessment Venues

Mindscape Education has established SBA Venues across the country where all learners can be hosted for formal assessments. These venues have competent markers and invigilators to facilitate the Mindscape Education assessments in accordance with the Assessment Policy and Procedures.

Please select an SBA Venue from the list attached:

___________________________________________________________________________________________

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Grade R

•Home Language

•Mathematics

•Life Skills

Grade 1

•Home Language

•Mathematics

•Life Skills

•Additional Language

Grade 2

•Home Language

•Mathematics

•Life Skills

•Additional Language

Grade 3

•Home Language

•Mathematics

•Life Skills

•Additional Language

Grade 4

•Home Language

•Mathematics

•Life Skills

•Additional Language

•Natural Science &Technology

•Social Science

Grade 5

•Home Language

•Mathematics

•Life Skills

•Additional Language

•Natural Science &Technology

•Social Science

Grade 6

•Home Language

•Mathematics

•Life Skills

•Additional Language

•Natural Science &Technology

•Social Science

Select a Home Language and a First Additional Language

English Home Language Afrikaans First Add Language

Afrikaans Huis TaalEngels Eerste Addisionele Taal

FOU

ND

ATI

ON

PH

ASE

IN

TER

MED

IATE

PH

ASE

SE

NIO

R P

HA

SE

• Printed Lesson Material :Textbooks, workbooks, readers and technology packs• Electronic Facilitator resources : Teaching schedules, assessment programs and resources• Formal Assessments: Termly assessment packs, June and November Exams

o Mindscape works on a 4 term year, please refer to Mindscape Calendar• Support Services and on-line assistance to parents and tutors.

English Home Language isiXhosa First Add Language (Grade 1 - 3 only)

Add: Teachers Guides at R1850 per grade, recommended for home schoolers. (e-guides available on Snapplify)

Add: Steam Robotics Package R4250, learners can use this set to Grade 4Add: Teachers Guides at R850 per grade, recommended for home schoolers. (e-guides available on Snapplify)

Your School-in-a-box includes - Grade R -3 • Printed Lesson Material :Textbooks and workbooks• Electronic Facilitator resources : Teaching schedules, assessment programs and resources• Formal Assessments: Foundation phase learners have continuous assessments throughout the year• Support Services and on-line assistance to parents and tutors.

Grade 7

• Home Language

• Mathematics

• Life Skills

• Additional Language

• Natural Science

• Social Science

• Technology

• EMS• Creative Arts

Grade 8

• Home Language

• Mathematics

• Life Skills

• Additional Language

• Natural Science

• Social Science

• Technology

• EMS• Creative Arts

Grade 9

• Home Language

• Mathematics

• Life Skills

• Additional Language

• Natural Science

• Social Science

• Technology

• EMS• Creative Arts

Add: Teachers Guides at R2200 per grade, recommended for home schoolers. (e-guides available on Snaplify)

Your School-in-a-box includes - Grade 4-9:

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STANDARD AGREEMENT

Mindscape Education is hereafter referred to as “Mindscape”.

1. This agreement is applicable to the completeapplication and becomes a binding SLA with theremainder of this application after the signing by theAccount Holder (if different to the Guardian), theLegal Guardian and Mindscape's representative. Allterms & conditions in the accompanying applicationform and the application for monthly instalment planwill be binding after the signing of the SLA by allrelevant parties.

2. I/We acknowledge and agree that the finalresponsibility for the education and training of my/ourchild(ren) remains with myself/us as parent(s) andthat Mindscape is merely a provider of products &services as an aid to support myself/us in my/oureducation and training responsibilities, and that thisis not an registration at the Department of Education.

3. I/We understand and agree that this SLA mustbe accompanied by a certified copy of theAccount Holder's identity document before anyproduct and/or services will be delivered or rendered.

4. I/We understand and agree that this SLA must beaccompanied with proof of payment of either the fullamount, or the deposit with a signed debit orderinstruction before any product or service will bedelivered or rendered.

5. Furthermore I/We agree to thoroughly check andverify the package received by Mindscapeimmediately on receipt and notify Mindscape within(5) five working days of any variances between thepacking sheet, the contents and the course materialordered. All discrepencies that are reported after the

(5) working day period will be at my/our expense,including postage, packaging and production costs.

6. I/We acknowledge and agree that Mindscapesproducts & services will remain the property ofMindscape as long as payments are due, andbalances are owing to Mindscape.

7. I/We confirm hereby that I/we take full responsibilityfor the grade choice, subject choices and subjectcombinations as stated in the LearnerInformation Section(s).

8. By signing of this SLA I/we undertake to payMindscape according to the agreed contractedamount according to the settlement information asstated above and in accordance with the terms andconditions included in the application for monthlyinstalment plan document that I/we have read,understood and signed.

9. I/We undertake to settle our outstanding balance bythe 1st October each year or as stipulated on theinvoice.

10. I/We understand that a re-registration for a newgrade and/or a new student registration from the same family will not be considered by Mindscapeunless the previous year's account has beensettled in full.

11. I/We agree that Grade 12 Candidate packages will

be purchased by no later than 28th February of the

year of writing Final Examinations and that the account, including examination fees, will be settled in full by no later than 30th of September in the year of writing the Final Examinations.

12. Any subject changes after the dispatch of the boxfor Grade 10 - 12 learners will require the purchaseof the necessary textbooks and prescribedbooks. I/We agree that the purchase of these newbooks will be at my/our expense being the Guardian/Account Holder's liability.

13. I/We agree that Mindscape may withhold theprovision of tests, examinations and reports if theMindscape account is in arrears.

14. I/We undertake to update Mindscape in writing of any change in my/our contact details, postal and/orresidential address and employment status within(30) thirty days of such occurrence. Should I/we notinform Mindscape of these changes we will not holdMindscape responsible of any form ofcommunication and/or correspondence not receivedand accept the consequences of the breakdown ofcommunication.

15. I/We undertake to adhere to all the relevantsubmission deadlines, portfolio requirements, yearprogramme, scheduled test and examination dates,rules and external moderation minimumrequirements and standards.

16. I/We agree and understand that failure to comply with paragraph 15 above may have a negative impact onmy child/ren's academic progress and could result ina grade being repeated.

17. I/We agree that the submission of all documentationwill be at my expense and I will take intoconsideration the required time frame of postageto ensure that all documentation is receivedby Mindscape by the due date.

18. I/We agree to uphold the integrity of Mindscape andthe authenticity of the curriculum and completion ofthe grade by ensuring that all tests, examinations and marking is done honestly, that the invigilation of testsand examinations is in accordance with the rules andguidelines as laid down by Mindscape and UMALUSI and that my child/ren will not have any access to therelevant marking memorandums whatsoever.

19. I/We agree to read all correspondence received fromMindscape thoroughly and take note of any changesof important dates or instructions that may appear inthis correspondence from time to time.

20. I/We hereby acknowledge and accept thatMindscape has a 14 (fourteen) working day windowperiod to dispatch the purchased products from thedate of receipt and acceptance of the requireddocuments, correct and complete application formand proof of payment of either the full amount orthe minimum payment deposit of 40%. Incompleteapplications will result in a delay in dispatch. Mindscape will not be held responsible for thedelay in the

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learner's/candidate's study program because of an incomplete submission.

21. I/we accept that all national and/or internationaldelivery costs, for whatever reason, includingshipping, postage, packaging, handling and productcost will be for my/our account.

22. All assessment material is the property of Mindscape and

23. I/we hereby declare that we are aware that certainsubjects have additional expenses and productsrequired that are not supplied by Mindscape such ascomputer software, drafting sets, equipment forexperiments/tests that should be performed for thepractical components of certain subjects etc. and that I/we will endeavour to provide these items at my/ourexpense.

24. I/we hereby certify that I/we are aware of anadditional fee of R380 plus courier for the change ofa subject after the 5 (five) day return period ofproducts received.

25. I/we hereby declare that I/we am/are aware thatMindscape and their subject advisors are notresponsible for any day-to-day teaching.

26. I/We accept that we are responsible for the fullamount of the course material as purchased byme/us regardless of cancellation of attendance toany support centre, discontinuation of studies bymy/our child(ren) or for any reason whatsoever.

27. I/We declare that we are aware that the MatricCertificate will be issued by UMALUSI.

28. Mindscape has the right with my/our approval toverify the information in this application formincluding and not limited to, obtaining a creditprofile from any recognised credit bureau, bank orother business institution, and on receipt of negativeinformation has the right to decline the application forpayment terms without prejudice.

not that of the student or guardian and that thestudent undertakes not to disclose, share,forward, copy or transmit any Mindscapematerial unless a Mindscape's express writtenpermission is obtained beforehand. Breach of thisclause is a material breach and will entitleMindscape to claim damages. thereof will beaccepted by me/us without dispute or argument.

29. I/We hereby declare and confirm that I/we am/are not bound by a court order (including administration,sequestration and or liquidation), and that accordingto my/our knowledge no such action is pending soon

30. If the services of a tutor centre or learning academyare enlisted, Mindscape must be informed of suchinstitutions to provide support and after sales serviceto the client. Please see Addendum 2 for completionby the centre.

31. This document embodies the full information andenrolment SLA and the agreement between me/usand Mindscape and any addition or change to this isnull and void, unless the change has been recordedin writing and has been agreed upon and signed byall parties.

32. I/We understand that the responsibility for thecompletion and submission of the Portfolio ofEvidence lies with me/us and I/we will ensure that alldeadlines and requirements are met as laid down bySACAI and Mindscape.

33. Should I as a parent wish to enlist the services of atutor centre / teaching institute, I take fullresponsibility of ensuring that the chosen institutionis complying with teaching standards that are in thebest interest of my child/ren

34. I understand that Mindscape does not accreditteaching institutes and has no affiliation with centresbesides for academic support

POPIA COMPLIANCEAs you may be aware the Protection of Personal Information Act (POPIA) came in effect on 1st July 2021.The purpose of the Protection of Personal Information Act, Act No. 4 of 2013 is to protect the personal data of all persons and further outlines how institutions should safeguard, collect, process, store, share and manage this information.

Disclosure of Information:We may disclose your personal information to service providers who are involved in the delivery of products and services to you. We will make every effort to ensure that your permission to disclose your information is obtained prior to disclosing same. Third parties and service providers are obligated, in their own right to ensure that they process your information in accordance with the POPI regulations and protocols. We may also disclose your information where we have a duty to disclose such information in terms of the law.

Information SecurityWe are legally obligated to provide adequate protection for your personal information that we have on record and to prevent unauthorized access and use of same. We will, on an ongoing basis, continue to review our security controls and related processes to ensure that your personal information remains secure.

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Grade R - 9 Declaration

I declare that:

The learner has successfully completed the grade prior to the one I am applying for on the CAPS curriculum.

When my final 2021 report is available, I accept the responsibility of submitting it to Mindscape before the end of January 2022. I understand that should I fail to submit a final report, I may be deregistered.

Parent / Account Holder acceptance on contract

ACCOUNT HOLDER:

I, __________________________________________(full names and surname),

(ID number : __________________________________) hereby confirm that I have read and fully understand the above terms and conditions and further that I am personally responsible for the payment of the account or any penalty cost or administration fees, as stipulated above and in the Application Form. I bind myself to these terms and conditions.

Thus done and signed at ____________________ on this ____________ day of ______________ 20___.

Signature:________________________________________________

PARENT / LEGAL GUARDIAN (IF NOT ACCOUNT HOLDER):

I, ___________________________________________ (full names and surname),

(ID number: ____________________________________) hereby confirm that I have read and fully understand the terms and conditions as stipulated above and in the application form. I bind myself to these terms and conditions.

Thus done and signed at ____________________ on this ____________ day of ______________ 20___.

Signature: ________________________________________________