Acceptance Form

"*" indicates required fields

This field is for validation purposes and should be left unchanged.
Please complete this form in BLOCK CAPITALS and return to the Admissions Manager with a deposit of £500 payable by:

1. CHILD DETAILS

Child's Name*
Proposed Term of Entry*

2. PARENT/GUARDIAN DETAILS

A guardian must be appointed under Section 5 of the Children Act 1989, by the court, by a parent with parental responsibility or by an existing guardian. Please fill in guardian details ONLY if there is any other person who has parental responsibility for the child.
Relationship to Child*

Name*
Address and Post Code*
Relationship to Child*

Name*
Address and Post Code*

3. ADDITIONAL INFORMATION

Please inform us in a separate covering letter if:

 
  • There is anyone else whose consent to the child coming to the school is required.
    •  
  • If it is proposed that anyone other than the named contacts overleaf will pay or guarantee payment of the fees.
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  • If duplicate school reports are required for a named contact residing at a different address to the child.
    •  
  • If invoices should be sent to an address other than the named contact overleaf.
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  • The child has any known medical conditions, health problems or allergies.
    •  
  • The parents are separated or divorced.
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  • There are any court orders in relation to the child , e.g. as to parental responsibility, residence, contact, prohibited steps, specific issues or periodical payments; or in relation to the parents or if either is an undischarged bankrupt or subject to an individual voluntary arrangement.
    •  
  • The child may be unable to play a full part in the games and sporting curriculum of the school.
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  • There is any reason to suspect that the child has any learning difficulties or special educational needs, or if there is a family history or any learning difficulty.

4. DECLARATION

Terms and Conditions*
Fees are the joint and several responsibility of each person who has signed this Acceptance From. If a third person will be responsible for the payment of fees please let us know by separate cover, indicating relationship to family.
First Signature*
Second Signature*
Hollygirt School, Elm Avenue, Nottingham NG3 4GF / Tel: 0115958 0596 / www.hollygirt.co.uk / info@hollygirt.co.uk