Summer School Form

CLASSES WHICH YOU ARE APPLYING FOR (PLEASE TICK)

STUDENTS PERSONAL DETAILS

Surname* First name* Date of Birth* Age* School Year

*MaleFemale

Address (line 1)* Address (line 2) Town / City* Postcode* Home telephone no*

Parents/Guardians Details

We require TWO emergency contacts for Saturdays

#1

Name* Mobile Number:* Email:* Relationship to child:*

#2

Name* Mobile Number:* Email:* Relationship to child:*

YOUR CHILD’S HEALTH

Does your child have health issues we should know about for their comfort and safety?*YesNo

If you answered yes (above) please give more details

EDUCATIONAL INFORMATION

Present School* Address of school

Is this an AEN or specialist school?*YesNo

PREVIOUS EXPERIENCE

Please list any relevant qualifications or experience already gained.

(N.B. This is for information only - no previous experience is necessary.)

Do you have any special needs we should be aware of?*YesNo

If YES, please attached details or give explanation below:

FURTHER INFORMATION

Please outline below any further information you would like us to have.

MONITORING SURVEY

Please tick box

Black / Black BritishCaribbeanAfricanAny Other Black Background

Any other ethnic background (please specify)

Is English your first language?*YesNo

If NO, please indicate first language

The school needs certain details to respond to regional surveys on education.
The information asked for here is used for statistical purposes and has no bearing on your application.

SIGNATURES

I support the above application to join BRIT Kids.

Parent/Guardian’s Signature: Date

CHECKLIST FOR APPLICANTS

Please check the following to ensure you have completed the form correctly.*All sections of the form are completeThe form has been signed by a parent/guardian