Admission Form

Your first name *

Your last name *

Your email *

Pupil's Legal Surname *

Pupil's Surname

(If different from legal surname)

Pupil's Forename(s) *

Gender *

Male

Female

Pupil's Date of Birth *

Parent 1: Forename *

Parent 1: Occupation

Parent 1: Address

If different from child's address

Postcode

If different from child's address

Parent 1: Email address *

Parent 1: Mobile number *

Parent 1: Home / Work phone number

Please enter both contact numbers if applicable

Parent 2: Forename *

Parent 2: Occupation

Parent 2: Address

If different from child's address

Postcode

If different from child's address

Parent 2: Email address *

Parent 2: Mobile number *

Parent 2: Home / Work phone number

Please enter both contact numbers if applicable

With whom does the child live?

Name of pupil's previous school *

(Including pre-school/nursery)

Date of last attendance *

Emergency Contact (1): Name *

Please provide details of two persons willing to be contacted in case of an emergency if parent is not available.

Relationship to child *

Secondary contact number *

Please specify whether mobile/home/work phone

Emergency Contact (2): Name *

Please provide details of two persons willing to be contacted in case of an emergency if parent is not available.

Relationship to child *

Secondary contact number *

Please specify whether mobile/home/work phone

Child in public care? *

Yes

If yes, which authority?

How will the pupil travel to school? *

Walk

Bus

Car

Bike

Other

Religion *

Hindu

Jewish

Christian

Sikh

Muslim

No religion

Other

Ethnicity/Race *

White - British

White - Irish

Any other white background

Asian - Indian

Asian - Pakistani

Asian - Bangladeshi

Any other asian background

Black - Carribean

Black - African

Any other black background

Mixed - White & Black Caribbean

Mixed - White & Black African

Mixed - White & Asian

Mixed - Any other mixed background

Chinese

Any other ethnic background

Please select one box only, indicating the category that best describes your ethnic origin

Home Language (lanugage spoken in family home) *

Country / Place of Birth *

Name of Doctors Surgery *

Name of Doctor (if applicable)

Please provide a signature.

Noticeboard

Reminder: Friday 1st April is the last day of Term 4.

Children return on Tuesday 19th April.