Junior School Application

Date Application Completed*

Full name of pupil (as on birth certificate)*

First Last

Term and year of entry*

Current school year

Date of birth*

Nationality*

Title of person(s) with parental responsibility*

Full Name(s) of person(s) with parental responsibility*

First Last

Title of person(s) with parental responsibility

Full Name(s) of person(s) with parental responsibility

First Last

Full Address of person(s) with parental responsibility including postcode*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email Address 1 – Parent/Guardian*

Phone Number 1 – Parent/Guardian*

Email Address 2 – Parent/Guardian*

Phone Number 2 – Parent/Guardian*

Occupation(s) of person(s) with parental responsibility*

Siblings already attending Talbot Heath*

Schools or nurseries attended with dates, and address of present school and nursery*

Is your child to follow Talbot Heath's normal course of Religious Education?

Yes

No

Does your child have any history of learning difficulties such as Dyslexia, Dyspraxia, etc?

Does your child have any visual, aural or other physical impairment, which might require consideration during the entrance procedure or during her time at the school?

I/We hereby apply for the admission of*

to the School, from and including the year and term mentioned in the application form.

I/We request that the name of the above-named child be registered as a prospective pupil AND I/we agree to pay for the non-refundable Application fee of £100 (overseas applicants £150)

Select Application Fee*

£100 – UK

£150 – Overseas

Hidden

Select Application Fee

£100.00 (UK)

£150.00 (Overseas)

I/We have read and understand the Declaration below

Yes

No

PLACE REQUEST

Junior School

Declaration

I/We understand that

Please type in capitals the names of all persons with parental responsibility for the pupil being registered to confirm your form submission.*

Data Protection: Talbot Heath School Trust Ltd, as a Registered Data user, has an obligation to comply with the principles of the Data Protection Act 1998. Any personal details collected on this form will only be used for the purpose(s) stated. This information will be kept securely and will not be passed on to any third parties without the data subject’s consent. Information will not be kept longer than is necessary. Any queries regarding Data Protection should be sent to the Headmistress.

Total

Credit Card

Date

School life

Parents, Pupil and staff Area

Charity

Junior school

Senior school

Sixth form

TH Junior School Application

PLACE REQUEST

Declaration

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