Shrewsbury House School Registration Form (Please Complete

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Shrewsbury House School Registration Form (please complete in block capitals) Boy’s surname: Father’s title & full name: First names in full: Address: (Name by which he is called): Proposed year of entry: Y Y Y Y Postcode: Age when starting: Home tel No: Boy’s date of birth: D D M M Y Y Mobile No: If you want your son to sit for a conditional place for year 3 entry please tick box Email address: For an occasional place entry into years 4-8 please tick box Occupation: Nationality: Mother’s title & full name: Principal language spoken at home: Religion: Any special details of which we should be aware Address: (i.e. medical (including allergies), disabilities, learn- ing difficulties, dietary requirements, family): Postcode: Any special arrangements that need to be made for Home tel No: your child to sit the entrance test? Mobile No: Email address: Occupation: For office use only: please turn over to complete the application Shrewsbury House School is part of the Shrewsbury House School Trust Limited: A company limited by guarantee. Registered in England - Company No. 01411417 & Registered Charity No. 277324 Name and address of present school: Postcode: Name of Head: How did you hear about Shrewsbury House School? Please mention any relevant connection with Shrewsbury House School, including brothers attending or who have attended SHS: Senior school for which he is entered (if any): We request that the name of our above-named child be registered as a prospective pupil. A cheque/payment details for the non-refundable registration fee of £150 is enclosed/a transfer payment of £150 has been made. Please make cheques payable to Shrewsbury House School Trust Ltd. 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. We understand also that the school (through the Headmaster, as the person responsible) may obtain, process and hold personal information about our child, including sensitive information such as medical details, and we consent to this for the purposes of assessment and, if a place is later offered, in order to safeguard and promote the welfare of the child. Bank Details Natwest: Sort Code: 60-60-02 Account No: 43107036 Please use your child’s initial and surname as reference. Please return this form with the £150 fee to: The Registrar, Shrewsbury House School, 107 Ditton Road, Surbiton, Surrey, KT6 6RL First signature: Name in full: Relationship to child: Date: D D M M Y Y Second signature: Name in full: Relationship to child: Date: D D M M Y Y.

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