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Reception to Year 6 Entry Application

Reception to Year 6 Entry Application

*Required

We/I* wish to reserve a place on the school list with effect from (start date):* Year group on entry (e.g. Reception, Year 1 etc)* Child's surname, as shown on their birth certificate:* Child's first and other names, as shown on their birth certificate:* Name used daily, if different from above: Date of Birth: required (dd/mm/yyyy)* Religion:* Nationality:* Gender:*

Is English your child's first language?*YesNo

Which other languages are spoken at home?* Name and address of current school/preschool/Nursery (if applicable): Post Code: Name(s) and date of birth of any siblings:* Please tick payable £90 registration fee as appropriate:*

Who has parental responsibility for the child*MotherFatherJoint

Who has legal contact with the child?*MotherFatherJoint

Are parents jointly responsible for your child's education?*YesNo

Father's Contact Details

Prefix* Name:* Address:* Home Telephone Number: Work Telephone Number: Mobile Number:* Email Address:* Occupation

Mother's Contact Details

Prefix* Name:* Address:* Home Telephone Number: Work Telephone Number: Mobile Number:* Email Address:* Occupation Please indicate with which parent the child normally resides:*

Alternative contact who could collect your child in an emergency:

Alternative contact 1:

Relationship to child:* Name:* Address:* Phone Number:*

Alternative contact 2:

Relationship to child:* Name:* Address:* Phone Number:*

Who is responsible for the payment of the bill?*ParentsCompanyOther

Billing address, if different from home address: Please specify any learning difficulties or medical conditions your child may have. (You will be asked to complete a more detailed medical form once a place has been offered to your child): Please specify any dietary requirements: Any other special requirements or information about your child of which the school should be aware: How did you first hear about Rupert House School?* Do you have any previous connections with the school?

The Friends of Rupert House is a volunteer parent body who organise social events within the school. Are happy for your details to be passed on to The Friends of Rupert House?*YesNo

We undertake to give a full term's notice in writing, before the withdrawal of our son/daughter and we understand that in the absence of such notice, the payment of a term's fees will be required by the Governors.'*I Agree

We/I have made a bank transfer for £90 as a non-refundable registration fee. For children entering the school in Year 1 and above a place will only be offered once your child has visited the school and, where appropriate, a satisfactory reference from the current school has been received and all obligations have been met. At that point, a deposit of £600 is required, which is held until your child moves to their next school. For children entering Nursery or Reception, the deposit is payable 18 months prior to entry.

Bank Transfer HSBC Account Name: Rupert House School (Henley) Ltd
Sort Code: 401916
Account No: 81525530
Reference: Child's Surname

Signed:

Father* Mother*

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Rupert House. 90 - 92 Bell Street,
Henley on Thames, Oxfordshire, RG9 2BN

T: 01491 574263

E: office@ruperthouse.co.uk

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