queen's gate registration form
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7/28/2019 Queen's Gate Registration Form
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REGISTRATION FORM
Registration Form (to be completed by parent or guardian)PLEASE USE BLOCK CAPITALS
Surname of Child ...
First names (in full) ...
Preferred name ...
Date of birth ...
Nationality: ...
Proposed date of admission (term and year) ...
Languages (1st) (2
nd).
(If English is not the first language,please indicate level of fluency)
Religion (It is not mandatory to enter your daughters religion, but it would be helpful if you do)
Parents Details *Father *Mother
Title . .
Name . .
Address . .
Occupation . .
Nationality . .
Home Tel . .
Work Tel . .
Mobile . .
E-mail . .
Fax . .
*Please indicate preferred contact for correspondence
Full name and address of Guardian, if applicable. (Please note that the appointment of a Guardianis compulsory if both parents are non-UK residents).
Guardian Contact Numbers: Home tel . Work tel .
Mobile . E-mail .
You must attach a copy ofyour daughters passport and, where applicable, her current visa to
the Registration Form. Please indicate the date of renewal of the visa and any information wemay need to be aware of regarding your daughters visa status. If your daughter holds a
Dependents Visa then copies of the appropriate parents passport and visa are also required. If
your daughter requires a Confirmation of Acceptance for Studies (CAS) to join the School you
will be required to reimburse the School for the costs of issuing this document.
Please attach
Photo here
For Office Use:
Entry Form:
Entry Year:
Mahmoud
Jude
26/08/1999
British
Term 1, Year 10
English Arabic and French
Muslim
Ali Mahmoud Yousra Shanshal
POBox 42450 POBox 42450
British British
026676393 026676393
+971506176642+971506136542
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7/28/2019 Queen's Gate Registration Form
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Queens Gate School, 133 Queens Gate, London SW7 5LE
www.queensgate.org.uk
Please mention here the names of any other members of the family attending the school or registered
for entry, or any other connection with the school ...
Please state name and address of the present school (with date of entry)
Name of Headteacher
Are there any circumstances relating to your childs health of which the School should be
aware? Please tick as appropriate:
Allergies [ ]
Dyslexia [ ]
Dyspraxia [ ]
Hearing impairment [ ]
Visual impairment [ ]
Other
....................
Declaration
We request that the name of the above-named child be registered as a prospective pupil AND weenclose a cheque for the non-refundable Registration Fee of 100.00 (cheques to be made payable toQueens Gate School Trust Limited).
We understand that:
1. registration of our child as a prospective pupil does not secure our child a place at the Schoolbut does ensure that our child will be considered for selection as a pupil at the school;
2. the School may process personal data about our child, including sensitive personal data such asmedical details, for the purpose of administering its list of prospective pupils and administeringits selection procedures and we consent to the processing of our childs personal data(including sensitive personal data) for these purposes;
3. in the event that our child is offered a place at the School, such an offer will be subject to theSchools Terms and Conditions for the provision of educational services, which will bind us inthe event that we accept the place.
First Signature Second Signature
... .
Name in full . Name in full ..
Relationship to child . Relationship to child ..
Date . Date ..
A copy of the current edition of the standard terms and conditions isavailable on request.
None
British School Al Khubairat,
September