Please complete this form if you wish your child to be admitted to the One in a Million
Free School for the School year commencing 3 rd September 2012.
Child’s Details
First name
Other forenames
Surname
Known as
(if the child has a preferred name)
Date of birth
Gender
Present primary school
Child’s address
(this is the address at which the child lives on a permanent basis or ordinarily)
Month
Male
Year Day
Female
Is the child in the care of the local authority Yes / No*
Does you child have a statement of special educational needs? Yes / No*
Is your child currently receiving Free School meals? Yes / No*
*delete as appropriate
Parents or Guardian Details
First name
Surname
Relationship to child
Parent or guardian’s address
(if different from the child’s)
Post Code
Telephone number
Mobile
Email address
Author: Nigel Shaw Page: 1 of 2 Date: June 2012

Declaration by Parent or Guardian
I have read the information provided by the One in a Million Free School and I declare that the information given on this form is accurate and subject to verification. Where required I can provide documentary evidence for the above statements.
Please note that in the event of the One in a Million Free School being over-subscribed there is no guarantee that a place will be available at the school for my child.
I understand that the person who originally signed this form must sign any alterations.
I understand that the information provided on this form will be processed in accordance with the requirements of the 1998 Data Protection Act. It will be treated as confidential and will only be used for the purposes of the provision of education.
The information may also be processed to ensure the health, safety and welfare of any child prevent or to prevent or investigate alleged fraud or criminal offence.
Signed by ___________________________________ Date __________________
PRINT NAME ___________________________________
_______________________________________________________________________
Need help completing the form?
If you have any questions or need any help completing the form please do not hesitate to contact myself Nigel Shaw or another member of the team at One in a Million.
Our telephone number is 01274 723439.
Our e-mail address is freeschool@oneinamillion.org.uk
Author: Nigel Shaw Page: 2 of 2 Date: June 2012