Admissions Application Form for 2017

PLEASE NOTE: the Admission application form is for Yr 3 places. ALL information on the form must be filled in (where appropriate).

Child's Surname* Child's first name(s)* Child's date of birth (DD/MM/YYYY)* Child's home address* Postcode* Full name of parent / carer* Email Address* Telephone - home Telephone - mobile*

Is your child eligible for either pupil or services premium?*YesNo

Declaration by Parent/Carer

I declare that the information I have given on this form is correct. I understand that if at a later date this information is found to be incorrect I may lose the place offered to my child.

The information collected on this form is to help arrange admission to Primary school. It may be shared with colleagues in the Education Services and the Department for Education. The full data protection statement is available upon request from the school.

Title* Full name* Date (DD/MM/YYYY)*

Filling in this form with your name acts as your signature.