Nursery Application form for January 2014

New Pupil Admission Form

Please complete this form and return to:

Admissions, Avanti Court Primary School, Carlton Drive,
Barkingside, Essex, IG6 1LZ

IMPORTANT NOTES
1. Please complete this form in BLOCK CAPITALS.
2. Section 1 should be completed by Parent/Guardian.
3. Those wishing to apply for one of the Hindu places then section 2 should
be completed by representative of a Hindu temple.
4. The original signed form should be returned by 4th July 2013.
5. If your child(ren) is(are) offered a place at this School you will be asked to
evidence 3 forms of identification: Birth certificate (child), proof of address
and medical card for the child for example.

Section 1

Child’s Details

First name(s) Surname

Date of Birth Gender (M/F)

Home Language First Language

Religion Dietary Requirements

Please tick preferred time for nursery

Morning (8.30 – 11.30)
Afternoon (12.15pm – 3.15pm)
Either

Sibling Information

Full name of sibling(s) in the School

Class of sibling(s) in the School

1
 Medical Information

Does your child have a medical

condition/allergies that we should know
about

Parent/Guardian Details
Title First names(s) Surname

Relationship to child

Home/contact address (including postcode) Daytime telephone

number

E-mail Address Mobile number

Emergency Contacts
Contact 1
Title First names(s) Surname

Relationship to child

Home/contact address (including postcode) Telephone number

Contact 2
Title First names(s) Surname

Relationship to child

Home/contact address (including postcode) Telephone number

2
 Additional Information
Please add any further information that you may wish the school to know about.
(E.g. you may wish to inform us of other important information about your child
and family. The School also needs to know if your child has any Special
Educational Needs)

I confirm the above information is correct

Signature of parent: ________________________________________________

Date: ____________________________________________________________

Section 2 (To be completed by a Hindu temple priest or representative)

Please tick only one box as appropriate:

The family regularly attend our Temple.

To the best of my knowledge, the family is not Hindu.

I certify that the applicant is personally known to me and that the above provided
information is correct.

3
 Hindu Temple Details
Temple name Temple address (including postcode)

Priest’s name Position

Contact number Email

Signature and official temple stamp: _____________________________________

Date: ______________________________________________________________