Late Transfer Registration Form - 2019 Entry
We recommend you refer to Section 3 of the Admission Policy 2019 which details the Late Transfer Procedure before completing this form. The policy is available on the school website at www.challoners.com under Admissions.

Data Protection:
Dr Challoner's Grammar School ('the school') respects your privacy rights and is committed to ensuring that it protects the information you provide on this registration form in accordance with the Data Protection Act 1998. The school will use this information for administrative purposes, which may include sharing some information with Buckinghamshire County Council's 'School Admissions' Team.

The information collected via this form is managed in line with our Data Protection Policy and Privacy Notices (Students and Parents) which can be found on our school website.

Student Details
Student First Name *
Your answer
Student Last Name *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Student Home Address
Address Line 1 *
Your answer
Address Line 2
Your answer
Town *
Your answer
County *
Your answer
Post Code *
Your answer
Home Telephone Number *
Your answer
Does the student have a sibling at Dr Challoner's Grammar School? *
If 'Yes' please enter sibling name
Your answer
Parent/Guardian Information
Parent/Guardian Title *
(Mr, Mrs etc.)
Your answer
Parent/Guardian First Name *
Your answer
Parent/Guardian Last Name *
Your answer
Parent/Guardian Address (if different from student)
Your answer
Parent/Guardian Mobile Number
Your answer
Parent/Guardian E-mail *
Your answer
Current Academic Year *
Previous Testing
Did the student take part in the 11+ Transfer Testing? *
If 'Yes' please give date of test
MM
/
DD
/
YYYY
If 'Yes' please give score
Your answer
Special Educational Needs
Does your son have any Special Educational Needs (SEN) ? *
Do you believe your son to be disabled within terms of the Disability Discrimination Act? *
If 'Yes' in either of the above cases please give details
Your answer
Additional Information: Evidence of Residency in Catchment:
If the main address of the child given on the registration form is in the catchment area of the school, evidence is required to confirm residency. This evidence should be one of the following:
- A Council Tax bill (for 2018/2019)
- A utility bill (gas or electricity) which is in your name and is no more than 3 months old.

The evidence should be scanned and sent via email to admin@challoners.com or a clear photocopy posted to the Admissions Manager at Dr Challoner's Grammar School, Chesham Road, Amersham, Bucks, HP6 5HA

Deadline date for registration form to be completed and received by the school is Monday 14th January 2019.
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