THE BULMERSHE SIXTH FORM - STUDENT REGISTRATION FORM

DATE OF ENTRY ……………………………………………………….

SURNAME / FIRST NAME
FEMALE/MALE / DATE OF BIRTH
HOME CONTACT NUMBER / PERSONAL EMAIL ADDRESS
PARENTS MOBILE NUMBER / PARENTS EMAIL ADDRESS
Last school in the UK:
Date of entry:
Date of leaving: / Students first language:
Main home language:
Religion:
Please complete this section if you have been educated outside of the UK
Country:
School:
Date of entry:
Date of leaving:
CONTACT PRIORITY / 1 / 2 / 3
Title: Mr, Mrs, Ms….
SURNAME
FIRST NAME
FEMALE/MALE
ADDRESS
Number/Road
Town
Postcode
Home contact number
Work contact number
Email
Other information
Relationship to student
Please indicate what you consider your ethnic background to be?
White - British
White - Irish
White - Traveller of Irish Heritage
White - Gypsy/Roma
White - Any other background (please state below)
Mixed - White and Black Caribbean
Mixed - White and Black African
Mixed - White and Asian
Mixed - Any other Mixed background (please state below)
Asian or British - Indian
Asian or British – Pakistani
Asian or British - Bangladeshi
Any other Asian or Asian British background (please state below)
Black or Black British - Caribbean...... Black or Black British - African ...... Any other Black or Black British background (please state below)...... Chinese...... Other......
I do not wish an ethnic background category to be recorded.
PERSONAL & MEDICAL INFROMATION
Family Doctor: Address: Telephone:
Health problems/information, e.g. poor hearing/asthma etc.:
Is your child adopted from care? YES/NO
Do you agree to your child being photographed YES/NO (including by a newspaper photographer in connection with activities within the school)
Can the student be given paracetamol? YES/NO
Lunch arrangements: school meal/ packed lunch /free school meal (form to be completed and evidence submitted)
Usual travel arrangements: Walk / cycle / school bus / public service bus / car/ car share / taxi / train / other
Education information - Please remember to bring your GCSE certificates that will be photocopied along with any other qualification that you feel the school would like to know
Other information - please make any other comments you feel would be helpful to us.
Parents ‘Guardians’ signatures:
I/We confirm the accuracy of the above information and will let the school know of changes as soon as possible. The sixth form team will predominately use email to communicate with parents so please ensure that email addresses are correct.
……………………………………………………………………………………………………………………………………….. Date…………………………………………………………………….