Selected Year ---Early YearsPrep SchoolSenior SchoolSixth Form
Gender ---MaleFemale
Child's Surname
Child's First Name
Address
Ethnicity ---AFRICANANY OTHER ASIAN BACKGROUNDANY OTHER BLACK BACKGROUNDANY OTHER ETHNIC GROUPANY OTHER MIXED BACKGROUNDANY OTHER WHITE BACKGROUNDBANGLADESHIBRITISHCARIBBEANCHINESEGypsyGYPSY/ROMAINDIANIRISHOther Gypsy/RomaPAKISTANIRomaWHITE - NORTHERN IRISHWHITE AND ASIANWHITE AND BLACK CARIBBEAN
Religion ---AnglicanBaptistBuddhistChristianChurch of EnglandChurch of GodGreek OrthodoxHinduIslamJewishMethodistMuslimNo ReligionOther ReligionPentecostalRoman CatholicSikh
Child's Date of Birth
Proposed Start Date
Adult Contact 1: Surname
Adult Contact 1: Relation to Pupil (e.g. mother, father, grandparent etc.)
Adult Contact 1: Title ---MsMissMrsMrDr
Adult Contact 1: Occupation
Adult Contact 1: Phone Number
Adult Contact 1: Email Address
Adult Contact 1: Home Address
Adult Contact 2: Surname
Adult Contact 2: Relation to Pupil (e.g. mother, father, grandparent etc.)
Adult Contact 2: Title ---MsMissMrsMrDr
Adult Contact 2: Occupation
Adult Contact 2: Phone Number
Adult Contact 2: Email Address
Adult Contact 2: Home Address
Names of any other members of the family who currently attend, are registered with or have any other connection to Priory School
Please provide us with details of any medical conditions (including allergies) or disabilities. Please list both physical and psychological conditions. Kindly note that withholding important medical details may result in your child's offer of a place being withdrawn, should we later discover that we do not have the facilities to cater to their needs.
Please provide us with details about any specific learning difficulties, e.g. dyslexia, dyspraxia, dyscalculia etc. Please send any relevant supporting documents (e.g. school reports, Educational Health Care Plans etc.) to admissions@prioryschool.net.
We request that our above-named child be registered as a prospective pupil. The total £50, non-refundable registration fee has been paid to the school by cheque, cash, card or by bank transfer to the following details: Account Name: Priory School Bank Name: Handelsbanken Account Number: 12292365 Sort Code: 40-51-62
We understand that the terms and conditions of the School will undergo reasonable changes from time to time as circumstances require and will apply in all our dealings with the School. We understand also that the School (through the Head, as the person responsible) may obtain, process and hold personal information about our child, including sensitive information such as medical details, and 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 the child.
In ticking the "I consent" boxes below, we accept that this acts in place of giving a written signature, to confirm that we have read and agreed with these terms.
Adult Contact 1: I consent
Adult Contact 2: I consent
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