If you prefer to email the Intentions Form, please copy, paste and complete the form below.


ST JOHN BOSCO CATHOLIC PRIMARY SCHOOL

 

INTENTION/ADMISSION FORM

 

Surname:

 

Legal Surname:

 

Forename:

 

Middle name:

 

Chosen name:

 

Gender:

 

Date of Birth:

 

 

 

 

 

 

 

Address:     

 

Post Code:

 

Telephone:

 

Email:

 

Please give details of all persons who have parental responsibility and anyone else you wish to be contacted in an emergency. Place them in the order that you wish for them to be contacted in an emergency.

Priority

Name / Relationship

Home Address / Phone / Mobile / Fax

Work Address Phone / Email

1

 

 

Tel:

Mobile:

 

 

Tel:

Email:

Parental

Responsibilty

Yes/no

 

 

2

 

 

Tel:

Mobile:

 

 

Tel:

Email:

Parental

Responsibilty

Yes/no

 

 

3

 

 

Tel:

Mobile:

 

 

Tel:

Email:

Parental

Responsibilty

Yes/no

 

 

Religion :

 

Baptism Date :

Church of Baptism :

(Please provide proof of Baptism eg Baptism Certificate or Supplementary Faith Form

Any Siblings/Half Sibling

 Name                          D.O.B.               School

1.

2.

3.

4.

Please provide Details of current and previous Nursery, Child Minder or Childcare provision with

Date            Name of Provider              Address

 

 

 

 

 

 

                                   

Medical Practice:

 

Address:            

 

 

Telephone Number:

 

Medical Condition(s)

 

Is your child on Medication?

Does your child have any allergies?

Does your child attend a clinic?

Is your child right or left handed?

Dietary Needs

 

Dietary Preferences

 

Meal Arrangement  

School Meal

Packed Lunch    please tick box

Travel Arrangements

 

please tick the appropriate choice

 

Bicycle

 

Train

 

Car/Van

 

Walk

 

Taxi

 

Bus

 

Car Share

OTHER

Route

 

Ethnicity :

 

Home Language:

 

Any other language:

 

 

Data Protection Act 1998:  The school is registered under the Data Protection Act for holding personal data. The school has a duty to protect this information and to keep it up to date. The school is required to share some of the data with the Local Authority and with the DCSF.

I confirm that I appear on the Electoral Roll at the above address.  If you have recently moved into a property a letter of confirmation from your estate agent or solicitor may be required as proof of residence.

Signature:

Date: