APPLICATION FOR ADMISSION Academic Year / Details of Child Name* Surname* Date of Birth* Age* Gender* MaleFemale Details of Primary Contact Name* Surname* Phone Number* E-mail* Details of Secondary Contact Name Surname Phone Number E-mail Contact Address Town, street, house number* Post code* Medical Conditions (please give full details) Any special diet requirements (please give full details) Anything else you would like to inform the school about I certify that information is given above is true: I give permission for the use of photo/ video of my child publicity: Yes One + Two