Portsmouth Primary Application Form

APPLICATION INFORMATION
Purpose of Application:*

General Entry6th Form EntryOther Grade
E-mail of Parent/Guardian completing form:*
Date :*

DayMonthYear
ENTRANCE INFORMATION
Grade applied for
Last grade in previous school
School Year :
Estimated Entrance Date*

DayMonthYear
STUDENT INFORMATION : PERSONAL
Full Name :*

First NameMiddle NameLast Name
Gender

FemaleMale
Address

Street Address

Street Address Line 2

TownParish

Postal / Zip Code
Date of Birth :*

DayMonthYear
Age - Year
Age - Month
Submit passport-size picture of applicant :

Upload a File

Cancelof
Nationality
Country of Birth :
Citizenship :
Religious Affiliation :
Denomination :
Past School Information
Last school attended :
Past School Address :

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Years attend starting :

DayMonthYear
Years attended ending :

DayMonthYear
Grade :
Do we have your permission to make contact with this school's administration about your child/ward ? If yes, please provide the required information below.
Permission Information :*

YesNo
Name of contact person :

First NameLast Name
Title of contact person :
Email Address :
Phone Number :

Area CodePhone Number

Emergency Contact Information
Please note that in the case of an emergency, the parents will be called first. If no contact can be established with either parent, the school will make contact with the emergency contacts listed below in order of their names.
Name :*
Relationship to student :*
Contact #*
E-mail*
Name :
Relationship to student :
Contact #
E-mail
Name :
Relationship to student :
Contact #
E-mail
Name :
Relationship to student :
Contact #
E-mail
Name :
Relationship to student :
Contact #
E-mail
Parent/ Guardian Signature

Clear
Date

DayMonthYear

Grade Collection
Do you/the student have/has any siblings/relatives attend/attended Portsmouth Primary School :

YesNo
Name

First NameLast Name
Relation :
Year :

APPLICATION INFORMATION