Bishop Challoner

Catholic Collegiate School

BOYS SUPPLEMENTARY FORM FOR STUDENT ADMISSION

2011-2012
Students Details

Forename Surname

Middle Name(s) Chosen

Name

D.O.B.

Address

Postcode Home Tel No.

Parents/Carers Details: Please give details of all persons who have parental responsibility

Mother Address/Home Tel No. Day Telephone No.

Parental Responsibility? YES/NO

Father Address/Home Tel No. Day Telephone No.

Parental Responsibility? YES/NO

Address/Home Tel No. Day Telephone No.

Parental Responsibility? YES/NO

Details of sisters or brothers in Bishop Challoner School (must be in attendance (or expected to be) in
September 2011):

Religious Affiliation (please circle)

Catholic Church of England Other Christian Hindu Jewish

Muslim Sikh No Religion Other (please give details)

Name of Parish Priest (if applicable):

/opt/scribd/conversion/tmp/scratch22266/31532213.doc
Name of Church or place of worship:

Is there a pastoral, social or medical reason for your child to attend Bishop Challoner?

YES NO

If the answer is yes you must attach letter from a relevant professional e.g. doctor or social worker

/opt/scribd/conversion/tmp/scratch22266/31532213.doc