Pupil's First Name

Pupil's Surname

Date of Birth

Gender

—Please choose an option—MaleFemalePrefer not to say

Proposed Date of Entry

Proposed Year of Entry

—Please choose an option—Year 7Year 8Year 9Year 10Year 11

Nationality

School Applying For

—Please choose an option—Secondary School5 Day Boarder7 Day BoarderInternational School

Name and Address of Present School

Head Teacher's Name

Class Teacher's Name

School Phone Number

Student UPN

Title

—Please choose an option—MrMrsMsMissDrProfessorSirMadamOther

First Name

Surname

Address

Home Telephone Number

Work Number

Mobile Number

Email

Title

—Please choose an option—MrMrsMsMissDrProfessorSirMadamOther

First Name

Surname

Address

Home Telephone Number

Work Number

Mobile Number

Email

Name of Guardian

Email

Address of Guardian

Mobile Number

Home Number

Please specify any known disability, medical condition and/or diagnosed learning difficulty

How did you hear about our school?

Were you referred by a parent?

—Please choose an option—NoYes

Name of Parent who referred you

Religion

Church Affiliation (Non-SDA)

SDA Church

Pastor

Any Other Comments