1. education
2. school

REGISTRATION
FORM
Registration Form
1.
Family Name / Surname of your Child:
First Names:
(Please underline the name generally used.)
Date of Birth: dd/mm/yy
Boy
Girl
Nationality
First Language
Religion
Year of Entry:
1st, 2nd or 3rd Term
Please indicate which Year Group you are applying for:
Foundation: FS1
2.
FS2
Key Stage 1: Y1
Y2
Key Stage 2: Y3
For Non Native English speakers:
Child’s First Language
Child’s Second Language
Other Languages spoken
Main Language spoken at home
Is English used at home
3.
Yes
No
Father’s Title, Full Name and Address:
PO Box:
Business Telephone:
Home Telephone:
Business Email:
Home Fax:
Business Mob:
Home Email:
Occupation:
Mob:
Employer’s Name:
Duplicate Report
All Mailings
Emergency Contact only
REGISTRATION
FORM
4
Mother’s Title, Full Name and Address: (if different from above)
PO Box:
Business Telephone:
Home Telephone:
Business Email:
Home Fax:
Business Mob:
Home Email:
Occupation:
Mob:
Employer’s Name:
Duplicate Report
5
All Mailings
Emergency Contact only
Please provide us with details of any medical conditions (including allergies), disabilities or learning difficulties
of your child. You must disclose any factor that may affect your child’s ability to cope independently within
the mainstream school environment. If your child has learning difficulties and has an IEP, this must be
presented as part of the application. Failure to disclose any learning difficulties or medical conditions at
the time of application may result subsequently in a place being withdrawn. Any offer made by the school
is subject to being able to meet the individual needs of the child.
Has your child ever been diagnosed with any of the following:
Yes
Dyslexia
Dyscalculia
Dyspraxia
Learning Difficulties
Language/Speech Disorders
ADD/ADHD
Autism
Emotional or behavioral difficulties
Is your child currently taking any medication?
If yes please give details
No
REGISTRATION
FORM
Notes:
Acceptance of the registration does not constitute an offer of a place;
All dealings between the School and parents are subject to the standard Terms and Conditions of the
School, which change from time to time.
All assessment results are final. We do not disclose actual results nor do we enter into correspondence
about individual results.
DECLARATION
I/We understand that the standard Terms and Conditions of the School will undergo reasonable changes from
time to time as circumstances require and will apply in all my/our dealings with the School. I/We understand
also that the School may obtain process and hold personal information about my/our child, including medical
information, and I/we consent to this for the purposes of assessment and, if a place is later offered, in order to
safeguard and promote the welfare of my/our child. I/We undertake to abide by the Terms and Conditions
regarding the provision of notice should I/we wish to withdraw my/our child. I/We undertake to provide the
school with a legitimate Transfer Certificate in order to complete the registration process.
If this form is signed by one parent or guardian only, it is assumed that the signatory is signing on behalf of both
parents/guardians.
First Signature:
__ Second Signature:
Name in Full:
Name in Full:
Relationship to the Child:
Relationship to the Child:
Date:
Date:
REGISTRATION
FORM