Section 1 – Child’s Details(please print)

Child’s Surname:Date of Birth:

Child’s First Name: MaleFemale

Child’s CurrentPrimary School:

Father/Guardian Mother/Guardian

Full Postal Address:

Postcode:

Telephone Number: Mobil Mobile:

E-mail address:

Religion of Child:Has your child been baptised

If yes, when and where
Do you have parental responsibility for this child? / Yes / No
Is this child in the care of a local authority?
If yes, please provide confirmation / Yes / No
Has your child previously been in the care of the local authority
but has now been adopted? If yes, please provide confirmation / Yes / No
Does this child have a Statement of Special Educational Needs? / Yes / No

Important Notes

  • Please return this form to your current primary school by the closing date of 31 October 2013. If you attend another authority primary school, please return this form directly to the Admissions Team, People Directorate, Floor 2, Civic Centre, Glebe Street, Stoke-on-Trent, ST4 1HH
  • If you will be moving address in the near future, you must contact the School Admissions Team to inform them of your new address – proof of residency may be required

Section 2 – Secondary School Preferences

List the name of the school(s) where you would prefer your child to attend a secondary schoolin ranked order. You may give the reasons for your preferences below.

Names of Preferred Secondary School

1st:

2nd:

3rd

Reason for preference

Section 3 – Elder Brother or Sister

If your child has an elder brother or sister already at one of your preferred schools, who will still be in attendance in September 2014please give details below:

Name of Elder Brother or SisterSchool Date of Birth Current Year Group

Application for a place at a Catholic High School

If you have stated a preference for St. Thomas More Catholic College, St. Margaret Ward Catholic College, St. John Fisher Catholic High School or Painsley Catholic High School, you must also supply a copy of your child’s Baptism Certificate as evidence of faith. Failure to do so may affect the admissions category the child’s name is placed in. You may wish to contact the Admissions Team in relation to transport to these schools before making a nomination.

For applications to St. Joseph’s College, please see further information in our on-line booklet by visiting stoke.gov.uk/admissions, or contact the school direct.

Application for a place at St Peter’s Academy

If you have stated a preference for St. Peter’s Academy, you should contact the school direct on 01782 882500to request a Supplementary Information Form. You only need to obtain this Supplementary Information Form if you are applying for a Foundation place (practising Christians) or an Academy Council place (practising members of another faith community). The completed Supplementary Information Form must be signed by an appropriate faith leader and returned to the Academy Admissions Officer at St. Peter’s Academy by 31 October 2013.

Section 4 – Declaration and Signature of Parent/Guardian