APPLICATION FOR SENIOR SCHOOL CHANCE VACANCY
This must be accompanied by a non-refundable registration fee of £100 made payable to Channing School
For candidates taking the entrance examination overseas the registration fee is £125
SURNAME / Please attach a
passport size
photograph
FIRST NAME(S)
Please underline name known as
DATE OF BIRTH
NATIONALITY
RELIGIOUS DENOMINATION
LANGUAGE spoken at home
PROPOSED DATE OF ENTRY
PROPOSED YEAR GROUP
Parent / Guardian / Mother/Guardian / Father/Guardian
TITLE & FORENAME
SURNAME
ADDRESS
Postcode
TELEPHONE NUMBERS
Home
Work
Mobile
E-MAIL ADDRESS
PROFESSION/BUSINESS
PRESENT SCHOOL
with dates of attendance
HEADTEACHER
To whom reference may be made
POSTAL ADDRESS
Postcode:
Email address:
Tel. No: / Fax No:

CONTINUED OVERLEAF

CURRICULUM
INFORMATION / Has your daughter studied any of the following subjects
If ‘YES’ please indicate the length of time she has studied the subject:
French Yes  No ……………………………………………...
GermanYes  No………………………………………………..
SpanishYes  No………………………………………….…….
Any other language (please specify) …………………………………………...….
LatinYes  No……………………………………..…….…...
ADDITIONAL
INFORMATION / Does your daughter have any special needs we should take into account for the admissions procedure, or in the future? Yes  No
If you have answered ‘Yes’ please supply the details in a confidential letter with a professional report (if one is available).
If your daughter speaks a language at home, other than English, that you would like us to take into consideration please let us know:
HOBBIES AND INTERESTS
PLEASE LIST FAMILY MEMBERS WHO ARE PRESENT/FORMER PUPILS OF CHANNING SCHOOL
BURSARY / Do you wish to apply for a Bursary?Yes  No
If you answer ‘Yes’ you will be sent a Bursary Application Form to be completed and returned when your daughter is invited to attend an assessment morning.
HOW DID YOU HEAR ABOUT CHANNING SCHOOL?
ETHNIC ORIGIN OF CANDIDATE
This information is requested to ensure that we comply with our Equal opportunities policy and is not part of the admissions procedure. Please tick one of the categories
as appropriate. / White  Black  Black-African  Black-Carribean  Black-Other 
Indian  Pakistani  Bangladeshi  Chinese Japanese 
Other (please specify) …………………………………………………………………………….
Signature of
Parent/Guardian: / Date:
REGISTRATION FEE
I enclose a cheque for £100 (£125 for overseas)Cheques should be made payable to Channing School
I have made a Bank Transfer payment of £100 (£125 for overseas) to
Lloyds TSB Bank Plc A/c no: 18928160, Sort Code 30-93-80. Ensure your daughter’s name is added to payment.
For office use only
Date Application received:…………………………….. Registration fee £……….….. paid 
Bank: …………………………………………………… Sort Code: …………………………………

2 March 2017