Name of child *

First Name

Last Name

Date of birth *

MM

DD

YYYY

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Name *

First Name

Last Name

Phone *

(###)

###

####

Date of Birth

MM

DD

YYYY

Name

First Name

Last Name

Phone

(###)

###

####

Address

If different from above

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Date of birth

MM

DD

YYYY

Name

First Name

Last Name

Phone

(###)

###

####

Ethnic Group

We are required by the DFE to seek the ethnic group of each of our pupils. You are not obligated to provide this information in respect of your child, but we hope you feel able to do so. The Commission for Racial Equality strongly supports ethnic monitoring and has been consulted about these arrangements for obtaining information from parents

African

British

Indian

Chinese

Bangladeshi

Pakistan

White/ black carribbean

White/ asian

Any other black background

Any other mixed background

Any other ethnic group

I do not wish to give this information

Nursery Request (If applicable)

Please indicate your preference, however we can not guarantee this will be available.

Mornings

Afternoons

30 hours

N/A

Date *

MM

DD

YYYY