Type of Application^*

Pupil Surname^*

First Names^*

Preferred First Name

Date of Birth^*

Term and Year of Entry^*

Year Group on Entry^*

Gender

Nationality^*

First Language^*

If English is not your child's first language, please specify how long your child has been taught in English for

Are there any factors concerning your childs education which we should be aware? If yes, please give full details and if applicable, please enclose a copy of the relevant report (s)/educational psychologist assessment(s) (within 2 years).

Have you applied to other schools ?

Current School Name^*

Current School Address^*

Name of Headteacher^*

Email Address for Headteacher^*

Date Started

Date Due to Leave

Does your child have a sibling who is/was a pupil at Caterham School, or who is/was a candidate for admission ?

Enquiry Source

If other, please specify here

Caterham Bursaries (Senior School only)

11+ and 13+ Scholarships

If you know, please indicate the 11+ or 13+ scholarship application form you would like us to send to you

Sixth Form Scholarships

If you know, please indicate the 16+ scholarship application form you would like us to send to you

Name of Parent 1^*

Relationship to Child^*

Parent Occupation^*

Full Address^*

Home Telephone Number

Work Telephone Number

Mobile Telephone Number^*

Email Address^*

Name of Parent 2^*

Relationship to Child^*

Parent Occupation^*

Full Address

Home Telephone Number

Work Telephone Number

Mobile Telephone Number^*

Email Address^*

If the parent addresses are different, please indicate which address is your child's principle residence

I agree to the information being shared where necessary as explained above

Form completed by^*

Date Completed On^*

Email Address^*

Confirm Email Address^*

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