E No:

For office use

Birchfield Independent Girls School

30 Beacon Hill, Aston, Birmingham, B6 6JU

Tel: 0121 327 7707 I Fax: 0121 327 6888

Est: 1990. I Reg Charity No. 1053283

ADMISSION FORM

Family Name: _____________________ First Name(s):_______________________

Date of Birth: _____/_____/_____

Address: _____________________________________________________________

Post Code: ________________ Tel No. (Home): ___________________________

Mother Tongue: ______________ Other language(s) spoken: ___________________

Nationality: ___________________ Ethnicity/ Ethnic group:___________________

Please tick as appropriate:

Distance from school:

Expected means of travel to School:

Details of Siblings at Birchfield Independent Girls School

	Name of Sister	Date of Birth	Form	Year left the School
1
2
3
4

Parent(s) Details

Father’s Name:___________________ Mother’s name:________________________

Occupation:______________________ Occupation: __________________________

Emergency Tel. No:__________________ Mobile Tel No: _____________________

Next of Kin: ______________________ Address: ____________________________

___________________________________ Tel No. (Home): ___________________

Present School Details

Name of school: _______________________________________________________

Address: _____________________________________________________________

Tel No: ____________________ Reasons for leaving:_________________________

Date attended from:______________ To: _____________ Form/class: ____________

Medical details

Name of Doctor: ____________________ Address:___________________________

__________________________________ Tel No: ___________________________

Important medical Information: (eg Asthma, Allergy, Diabetes, Eczema)

Education

Any special Educational Needs:

_____________________________________________________________________

Decleration

Parent/ Guardian:

I undertake to honour the full requirements of my daughter’s agreed study programmed, and all the School regulations.

Provision of false information may affect the offer of a place.

Signature:______________________________ Date:________________________

Returning the form

Return the completed form along with a copy of the Large Birth Certificate to:

The admissions Officer at Birchfield Independent Girls School.

FOR OFFICE USE ONLY

‘E’ number:______ Acknowledged on:____________ Test taken on: ____________

Result: ________ Accepted:_____ Waiting List: _______ Admission date: ________

Apologies:_______ Registered fee/Deposit:_______________ Admission No:______

Comments:

_____________________________________________________________________

_____________________________________________________________________