St Benedicts - Registration Form (Year 12

Pupil's Details

Year Admission Required* Please select the year group of entry* Pupil's Legal First Name* Pupil's Preferred First Name Pupil's Middle Name Pupil's Legal Last Name* Pupil's Date of Birth*

Gender*MaleFemale

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Religion* Nationality* Present School/Nursery* Address of School* Headteacher* Previous School/s (with dates)*

Parent/Guardian Details

First Parent (or Guardian)

Title* First Name* Last Name* Relationship to Child* Home Address* Postcode* Email* Mobile Number* Religion*

First Parent/Guardian Occupation

Occupation* Company Name* Business Address* Postcode* Telephone Number*

Second Parent (or Guardian)

Title* First Name* Last Name* Relationship to Child* Home Address (if different) Postcode Email* Mobile Number* Religion*

Second Parent /Guardian Occupation

Occupation* Company Name* Business Address* Postcode* Telephone Number*

Additional Information

Please give details of any medical condition (Including Allergies) and Disabilities* Is your child or has your child been on the Special Educational Needs (SEN) Register at their current School?* Does your child have an Individual Education Plan (IEP)?* Does your child receive exam concessions* Has your child undergone an educational assessment or been seen by external agencies to support their development and education e.g. Occupational Therapy, Speech and Language?* If you have answered Yes to any of the above questions please enclose a copy of the supporting documentation e.g. IEP, educational assessment report. No file chosen Hobbies and Interests, Artistic, Dramatic, Musical or Sporting* Have you any previous connection with St Benedict’s School? (Old Priorian, Relatives, Etc.)* How did you first hear about St Benedict’s?* Does your child have any siblings (please complete details below if yes)*

Please complete the following
	Sibling Boy/Girl	Age	School
1
2
3
4

Please enter any other information here

Payment Details

VISA Requirements

Early registration is recommended. Offers of places are subject to availability and the admission requirements of the School at the time offers are made. A copy of the current edition of the Terms and Conditions will be supplied on request.

Please tick to confirm nationality of applicant pupil:*BritishOther European (please specify below)Other non-European (please specify below)

Nationality if non british All applicants are required to upload a copy of their child's passport. Please upload the file below (max file size - 5mb):* No file chosen All applicants are required to upload a copy of their child's full birth certificate (containing parents' details). Please upload the file below (max file size: 5 MB).* No file chosen

At the time of application are you living abroad?*YesNo

amount to pay*

Does your child require a visa to study in the UK?*YesNo

Please note that whilst completion of this form represents your confirmation that the applicant pupil has the
unconditional right to enter, live and study in the UK for the duration of the education offered by the School, proof
of documentation will be required.

Failure to give correct information will constitute a material breach of any agreements(s) entered into between the School and you in relation to the education of the applicant pupil entitling the School to terminate all and any such agreement(s) without any obligation to return any deposit or fees paid.

Declaration:

We request that the above-named applicant be registered as a prospective pupil. 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 Headmaster, 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. I/We further understand that the School (through the Head, as the person responsible) may obtain, process and hold personal information about me/us which may include financial information provided by me/us or by any licensed credit reference agency or information contained in any court orders, petitions or proceedings.

By checking the I agree box and choosing submit you agree that Failure to give correct information will constitute a material breach of any agreements(s) entered into between the School and you in relation to the education of the applicant pupil. This will entitle the School to terminate all and any such agreement(s) without any obligation to return any deposit or fees paid.*I agree

Registration Form (Year 12 - 16+ Entry)