For Coram House and Senior Schools

Please complete in BLOCK CAPITALS or type,
and return to the Head

CHILD:

PROPOSED DATE OF ENTRY: _____________

CHILD'S SURNAME: _____________

FIRST NAME(S): __________________________
(please underline first name used)

MALE OR FEMALE: __________

DATE OF BIRTH: _____________

AGE AT LAST BIRTHDAY: _____________

BOARDING OR DAY ENTRY: _________________

NATIONALITY: _____________

ADDRESS: __________________________

__________________________

__________________________

POST CODE: _____________

TEL: _____________ FAX: _____________

MOBILE: _____________

EMAIL: _____________



SCHOOLS:

PRESENT SCHOOL _____________

LEA OR INDEP? _____________

ADDRESS: __________________________

__________________________

TEL: _____________ FAX: _____________

HEADTEACHER'S NAME: _____________

DATE OF ENTRY: _____________


PREVIOUS SCHOOL: _____________

LEA OR INDEP? ______________

ADDRESS: __________________________

__________________________

TEL: _____________ FAX: _____________

HEADTEACHER'S NAME: _____________

DATE OF ENTRY: _____________



PARENTS:

MOTHER: NAME AND INITIALS: _________________

ADDRESS (IF DIFFERENT FROM ABOVE):

___________________________________________

___________________________________________

OCCUPATION: _____________

TEL: ____________________

FAX:____________________

EMAIL: ____________________


FATHER: NAME AND INITIALS: _________________

ADDRESS (IF DIFFERENT FROM ABOVE):
___________________________________________

___________________________________________

OCCUPATION: _____________

TEL: ____________________

FAX:____________________

EMAIL: ____________________


WHO HAS CUSTODY OF THE CHILD?

MOTHER______ FATHER _______

BOTH_____ OTHER ______

(PLEASE TICK WHERE APPROPRIATE)

GUARDIAN: (Essential if both parents overseas)

NAME: _____________

ADDRESS: __________________________

__________________________

TEL _____________ FAX: _____________


RELIGIOUS AFFILLIATION (IF ANY) OF PARENTS:

CONNECTION WITH SOCIETY OF FRIENDS (IF ANY):

MEMBER/ATTENDER: _____________

MONTHLY MEETING: _____________


IS EITHER PARENT AN OLD SCHOLAR OF ACKWORTH OR OTHER FRIENDS' SCHOOL?
_____________

HOW DID YOU HEAR ABOUT ACKWORTH SCHOOL?



CONDITIONS:

1 This Registration Form is subject to the School's regulations in force and does not commit the School to the offer of a place, or the applicant to accepting one.

2 School fees are payable termly in advance together with the cost of extras incurred during the previous term. Interest is charged on balances outstanding.

3 Full fees are payable during absences and parents are advised to insure against this contingency.

4 A full term's notice of intention to Withdraw a pupil or change from a boarding to day place must be addressed in writing to the Head. A term's fees will be required if due notice is not given or if a place, having been accepted, is not taken up.

5 Entrance tests for pupils entering for the Junior School and Senior School at ages 11, 12, 13 and 14 Will take place in January or February of the year of entry and a fill' report is required from the Head of the child's present school. At 16+ entry will be conditional on an interview and satisfactory references and GCSE results.

We agree to be bound by the above conditions if a place is offered and accepted. We enclose the registration fee (as detailed on fees sheet)


SIGNATURE(S) OF PARENT(S): __________________________

Date: _____________

GUARDIAN: (ESSENTIAL FOR PUPILS WHOSE PARENTS LIVE OVERSEAS)

THIS FORM MUST BE SIGNED BY BOTH PARENTS WHEREVER POSSIBLE.