Place Application

Fields with a * are compulsory, and must be filled in before you can submit your application.

Child's Surname: *  
Child's First Names: *  
Child's Date of Birth: *  
Child's Gender:

Address at which child is currently resident

During the admissions procedure you must notify the school in writing of any change of home address. Where a place is offered based on the address given on the preference form but it is subsequently found to have changed because you have moved home, the place may be withdrawn. Places offered on the basis of fraudulent or intentionally misleading information will be withdrawn. Your statutory right of appeal will not be affected.

Child's Address: *  
Child's Postcode: *  
Current School: *  
Please indicate which year you are applying for:

Parent's / Carer's Details

Parent Title: *  
Parent Initials: *  
Parent Surname: *  
Parent Phone: *    
Parent E-mail: *    
Parent Address(es) (if different from pupil's address):

Other Relevant Circumstances. Please include here any further information which you consider may be relevant to your application.

Important Information

I declare that all the information which I have provided is true. I understand that any school place offered on the basis of fraudulent or intentionally misleading information may be withdrawn.

Data Protection Act: the school maintains a Register of Applications which includes administration relating to pupils. Personal information provided on this form is treated in confidence and complies with the re- quirements of the Act. This information may be shared with Local Authorities and Primary Care Trusts.

Verification of Information: the school may verify information you have provided on this form which could in- volve contacting other Organisations who maintain appropriate records.