Personal Details of Student

Surname:

First name known by:

All first names:

Date of birth: Age: boy q girl q

Nationality: Language spoken at home:

Religion: Other languages spoken:

(Office use only) Class: Student number: Account number:

Date of entry:

Family Information

Fathers name:

Mothers name:

Fathers occupation:

Mother occupation:

Who is the fee payer?

Address 1.

Post code:

Address 2.

Post code:

Tel home:

Tel home:

Tel work:

Tel work:

Mobile:

Mobile:

e-mail:

e-mail:

Fax:

Fax:

To which address should the invoice & statements be sent? 1. q 2q

Any special family situation? (e.g. one parent family, divorced, step parents)

Details of other children in family:

1. Name: Date of birth: School:

2. Name: Date of birth: School:

3. Name: Date of birth: School:

Emergency Back-up please fill out two contacts

Name:

Name:

Relationship to student:

Relationship to student:

Tel No:

Tel No:

Place of contact:

Place of contact:

Scholastic Information - Please list all schools attended

Name and address of last school:

Type of school :

Period attended:

Name and address of previous school:

Type of school:

Period attended:

Name and address of previous school:

Type of school:

Period attended:

Reports received from previous schools? Yes q To be sent q

Is he/she interested in dance? Yes q No q

If yes, what type?

Is he/she interested in individual tuition in a musical instrument? Yes q No q

If yes, what instrument?

Students Health

Present state of health:

Any known allergies?

Has your child had q chicken pox q measles q mumps

Give details of all illnesses:

Note all vaccinations:

Any major accidents, injuries?

Any operations?

Any physical problems (period pains, head aches, travel sickness, physical habits etc)?

Is your child receiving any medication? (give name of medicine)

Has your child ever visited a psychiatrist or psychologist?

Any special diet? (e.g. vegan, vegetarian etc.)

Name of students own doctor:

Address:

Tel No.

General Information

Has your child ever been suspended or expelled from a school?

Has your child ever been statemented by a school psychologist?

Has your child ever been under the attention of social services or other child care organisation?

Homework details: (average weekly hours done, done willingly, etc)

To your knowledge, has your child taken or tried any street drugs?

Has your child been in trouble with the police?

Has, does your child smoke?

On average, how much TV does your child watch weekly?

How much pocket money does your child get?

Does your child have duties in the house?

How does your child contribute to the family?

Does your child have any other work or sources of income?

Attestation

      I attest that the above information is true. I have answered all the questions above to the best of my knowledge and I am not withholding any information.

      I have read, understood, signed and have a copy of the general regulations & conditions of admissions

      I will notify the school in writing if any of the above information changes.

Signature of parent:

Date: 50.00 registration fee paid: