Please Complete Both Sides of This Form

ENCLOSURE D

Supplementary Information Form in support of an application for a place at a Poole Infant, Junior or Primary School on religious grounds

If you are applying for a place for a child on religious grounds at Baden Powell & St Peter’s CEJunior School, Bishop Aldhelm’s Church of England (Voluntary Aided) Primary School, St Joseph’s Catholic Primary School, St Mary’s Catholic Primary School, Lilliput CE VC Infant School and/or Longfleet CE VC Primary Schoolplease complete Section A and ask your Priest/ Vicar/Minister/Leader of Church to complete Sections B and C.

PLEASE COMPLETE BOTH SIDES OF THIS FORM

Section A(to be completed by the Parent/Carer)

(Please do not use abbreviated or “known as” names)

Child’s First Name ______

Child’s Legal Surname ______

Date of Birth ______

Address ______

______Postcode ______

Section B (to be completed by Priest/Vicar/Minister/Leader of Church)

As school admission criteria vary you must answer all the questions below.

If it is not applicable, please mark N/A.

Q1: Has the child been baptised in the Catholic Church? Yes No

(please put a tick or cross in the box that answers the question)

If Yes, date of baptism ______

Note forSt Mary’s Catholic Primary School only:

A certificate or equivalent is essential as confirmation of Baptism/Formal Welcome/Formal

Enrolment or Service of Dedication, whichever is appropriate. Evidence of participation in

the Rite of Catholic Initiation of Children programme or a Formal Welcome into the Catholic

Church, will confer a similar status to that of a baptised Catholic child. This must be

provided directly to the school.

Q2: Has the child been baptised/enrolled in the Church of England or another mainstream

Christian Church*? Yes No

(please put a tick or cross in the box that answers the question)

If Yes, (a) date of Baptism/Service of Dedication/Enrolment______and

(b) name of Church ______

CONTINUED OVER THE PAGE

Section B (Continued)

(to be completed by Priest/Vicar/Minister/Leader of Church)

As school admission criteria vary you must answer all the questions below.

If it is not applicable, please mark N/A.

Q3: Has the child attended worship at least once a month at a recognised church or religious

group* for at least the last 6 months? Yes No

(please put a tick or cross in the box that answers the question)

If Yes, name of Church or Religious Group ______

* must be the same denomination as a member church of ‘Churches Together in Britain &

Ireland’ (see .uk for details) and/or the ‘Evangelical Alliance’ (see

for details).

Additionally forBishop Aldhelm’s Church of England (VA) Primary Schoolonly:

and/or be in agreement with the Basis of Faith and the Objectives of ‘Churches Together in

Poole’ (for details see ).

Section C(to be completed by Priest/Vicar/Minister/Leader of Church and then returned to

theParent/Carer)

I confirm that the information in Section B is correct

Name of Priest/Vicar/Minister/Leader of Church (please print)

______

Signature ______Date ______

Name of Church ______

Address ______

______Postcode ______

Parent(s)/Carer(s):When the completed form is returned to you please send it with your completed application form, or if you have completed an on-line application or live in another local authority area send it directly to:

The School Admissions Team

Children Young People & Learning

Dolphin Centre

Poole

BH15 1SA

Data Protection Act 1998

The Borough of Poole is a data controller for the purposes of the Data Protection Act 1998. This act regulates how we obtain and use information about individuals. The information you supply is being collected for the purpose of providing an education service but may be used for wider purposes and will be retained with your child’s education record. When you sign this document you are consenting to that use. The information may be shared with other service units of the Borough of Poole, those with parental responsibility, education establishments, other Local Authorities, the Department for Education, diocesan bodies, other service providers to enable them to fulfil their statutory duties and any appeal panel that is convened with respect to your application. Further information about the use of your personal information is available on or by contacting the Council’s Data Protection Officer.

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