St. Augustine’s C. of E. Primary School
Supplementary form for Parent(s)/Guardian(s)
Name of child: Surname ………………………..Christian names ………………………….
Date of birth ……………………….…
Application for:
Boy
Nursery
Girl
Reception
Date and place of Baptism/Infant Dedication …………………………………………..
…………………………………………………………………………………………………..
Copy of Baptism Certificate and/ or Infant Dedication (please attach to this form and
tick the box)
Name of parent(s)/guardian(s) …………………………………………………………….
Address ……………………………………………………………………………………….
…………………………………………….. Post Code ……………………………………
Daytime contact telephone number ………………………Mobile …………………….
The name of any older brother or sister who will still be attending the school at the
date of admission of the younger child ……………………………………………............
Place of worship where child and one of the parents / guardians regularly attends:
Name of place of worship …………………………………………………………………..
Address ………………………………………………………………………………………..
** Frequency of Attendance to be completed by Church Leader ( see overleaf)**
Where admission is sought under special medical or social circumstances criteria,
professional supporting evidence, e.g. from a doctor, psychologist or social worker
is essential. Such evidence must set out the particular reasons why St. Augustine’s
school is the most suitable for the child and the difficulties that would be caused if
the child had to attend another school.
You should obtain a medical form from the School Admissions Team (0161 909
6508) to be completed by the child’s GP or Consultant. These forms should be
returned direct to the School Admissions team for consideration by the medical
panel. Evidence of social reasons will be obtained from your child’s Social Worker.
(Please tick if you are attaching written evidence to support the above)
SIGNED………………………………………………………………Parent/Guardian
Date ………………………………………(Please note that the giving of false information will
render the application invalid)
Supplementary Form cont’d :
This page to be completed by Church Leader
(not the parent/guardian)
Name of child:
Surname ...............................................................Christian names .................................................................
Name of parent(s)/guardian(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Address . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..........
........................................................................
Post code . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Telephone . . . . . . . . . . . . . . . . . . . . . . . . . . . . Mobile . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Church attendance where parent(s) / guardian(s)/child regularly
attend. Regular attendance is taken to mean a minimum of fortnightly
attendance for at least a year prior to the 1st September in the year
before admission to the school.
Name of place of worship . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Address . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ….
Name of Vicar / Priest / Minister / Church Officer . . . . . . . . . . . . . . . . . . . . . . . . . . .
Address . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..
.........................................................................
Post code . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Telephone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I confirm that the parent/guardian/child named above has attended Church at least
fortnightly throughout the past year.
SIGNED………………………………………………………....................................................
Vicar/Priest/Minister/ Church Officer
Date………………………………………