Quinton House School Application Form

Thank you for your interest in applying for
Quinton House School.

Please use this application form to tell us about your child and your family.

It will take about 10 minutes to complete,
and you will need some supporting documents.

You can save your responses and return to this form at any time.
Child Information
First name *
Middle name
Surname *
Preferred name
Date of birth *

Day Month Year
Date
Gender *

Male Female
Gender value
Passport Nationality *
Nationality value
Religion
Religion value
Please confirm whether your child will require sponsorship from the school in order to obtain a visa to study in the United Kingdom.

Yes, my child requires sponsorship No, my child does not need sponsorship
Visa required
Year applying for *
Expected start date *

Day Month Year
Date
Academic Year *
Academic year value

Academic information
Languages
What is or will be your child’s first language/mother tongue?
Primary language value
Other language spoken
Other language value
Current school/most recent school attended
School name
School Address
Have you registered your child to any other school (Independent or State)? If so, please list them here:

Health information
Does your child have any medical condition? (e.g.. hearing impairment, speech therapy, mental health, asthma, diabetes, epilepsy, allergies)

Yes No
Please provide details: *

0/2000
Is your child currently or periodically taking medication or have any dietary requirements?

Yes No
Please provide details: *

0/2000

Development information
Has your child received any additional learning/behavioural/emotional support (either previously or currently)?

Yes No
Support program value
Please provide details

0/2000
Has your child ever received support for EAL (English as an additional language)?

Yes No
EAL program value
Please provide details

0/2000
Please list any other special hobbies or interests below:

0/100

How did you hear about our school? *
We would like to keep you up to date by email or post with information about upcoming school events, availability of school places and other relevant school-related news but we require your consent to do this. Please indicate below whether you are happy for us to use your information for this purpose. Our privacy policies can be viewed here.
*

Yes, please No, thanks
Marketing consent
To secure this registration a non-refundable fee of £75.00 is required.

You may pay by electronic bank transfer, quoting the reference ADMFEE{surname27}

Bank Account: 40021873
Sort Code: 40-41-70
IBAN: GB92MIDL40417040021873
Swift Code: MIDLGB22
Bank Routing No:
Account Name: Cognita Schools Ltd – Quinton House School
Bank: HSBC
Declaration
Early applications are recommended and will be considered in the order they are received. Offers of places are subject to availability and the admission requirements of the School at the time offers are made. A copy of the current edition of the Terms and Conditions will be supplied on request.

We request that the child named in this application be registered as a prospective pupil. We understand that the Terms and Conditions of the School will undergo reasonable changes from time to time as circumstances require and will apply in all our dealings with the School.
Should be Empty:

Child Information