‘StMary’s Catholic Primary Schoo! ‘Lea Road, Wrexham ‘Admission Form Name ofehild arc sn . Date of Birth Position in faily Adress ‘Telephone No, Home ose WOK ssnnssenne MOBILE Emergency No. Name No son Relationship to Child Nane [No sso Relationship to Child Fathers Name Mothers Name Religion Pais Plas of Baptism nsneenses Date Pleas enclose a copy ofthe Baptismal Certifiate, Name of Doctor Adress ‘Telephone No. ‘Any medical conditions Special sicumstancesw ADMISSION OF CHILDREN TO SAINT MARY'S CATHOLIC PRIMARY ‘SCHOOL, WREXHAM Form for obtaining a priest's reference in connection with an application for admission ‘The name and aderess othe Ghd Yor whom you are applying fora pace, ‘Your nari and adress (Give allnaries by which you are or Rave been Known, Give all aderesses at wrich you have resided in tne past three years) ‘Your telephone numbers and other contact dota ‘Whats your relations To Please give details of your religious aflaton, ‘Which parish, parishes places of worship do you normaly alend for Sunday Mass (or rst Mass on Saturday)? Give the name andi contact detals of the parish priests, ‘andthe names and addresses ofthe Churches, lease indicate below haw Frequenilyon average you alended Sunday Mass (or Wat ‘Masson Saturday) In the ast year. Place a tick i te box that most accurately eccribes your practice, Every Weak ‘nee every si weak: Three weeks infouwr |__| Onee every twe months “Two weeks in four ‘Once every six months ‘One woek in four ‘Once every year Please give any other supporting Infomation conceming your relgiousafllaion and ‘practice that you wish tebe taken ito account Parontal Declaration | cert that | am a member of the Catholic Church (as defined by the information nates accompany tif | cert thatthe information glven in his form is tue tothe best of my knowledge. | ‘accep that f any of this information is subsequently found to be false, my child will be able to lose ther ple at the school Signature: DaPriests Declaration * Please delete as epprepriate: * Loerty that has signed this sf declaration form an! that the information helshe has given Concerning hisher religious practice is accurate to the best of my kronfedge, + 1cortiy that__has signed this set declaration form. | have recorded below, undor Commer any reservations that | may have concerning the ‘accuracy ofthe information on religous pracie, Signature: Date: Paris Phone contact number: Patish Stamp Use a separate sheet for adltional comments if necessary ‘Note: Comploted copies 2 this farm and separate comment sheet should be retained by the Priest for reference purposos.