Civitas Schools' Application Form
Email address *
Child's Details
First Name(s) *
Surname *
Gender *
Date of Birth *
MM
/
DD
/
YYYY
Age *
School Year *
We can only offer places to children from Year 3 until Year 6. If your child is younger and you wish to apply, they will be put on the waiting list but we will only be able to offer them a space when they reach Year 3. Note: The form recognises Reception as 0 and Nursery as -1.
Please specify your child's allergies or medical conditions: *
Click "N/A" if this section does not apply to your child. If this does apply to your child, click "Other" and give details in the space provided.
Does your child have any special dietary requirements? *
Click "N/A" if this section does not apply to your child. If this does apply to your child, click "Other" and give details in the space provided.
Do we have your permission to take photographs of your child during lessons? *
We will use these pictures to help us promote the lessons and highlight pupils' accomplishments at Civitas Schools.
Additional information about your child
Which primary school does your child currently attend? *
Does your child receive Free School Meals? *
What language(s) does your child speak at home? *
Parent/Guardian Details
Title
Clear selection
First Name *
Surname *
Relationship to Child
Clear selection
Address Line 1 *
Address Line 2 *
City/Town *
Post Code *
Contact Number *
Email Address
I would prefer to be contacted by: *
Details for additional contact number
If we are able get through to the first contact number, for any reason, we will call this number.
Title *
First Name *
Surname *
Relationship to Child
Clear selection
Contact Number *
How did you hear about Civitas Schools?
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