Section 1 - Personal Details Child’s full name: Date of birth: Gender National Identity: Home Language: Do you have parental responsibility for this child? YesNo (A) Parents / Carers Name & Address: Postcode: Home Tel No: Mobile: (B) Father / Mother’s Name & Address (if different from A): Postcode: Home Tel No: Mobile: If you intend to apply for free school transport, proof of address is required when applying for a place for your child at Bishop Hedley Catholic High School. A Council Tax statement, recent utility bill or other proof of your address should be attached to this application form. (C) Please give the details of any other relative that can be contacted in case of an emergency: Name: Address: Home Tel No: Mobile: Please let us know immediately if any of the above details change so that we can update our records accordingly. If you need any assistance in completing this form please contact the school. I wish to apply for my son / daughter to be admitted to Bishop Hedley Catholic High School, commencing on: (Proposed date of admission). + Section 2 - School Details School currently / last attended: Year Group: If your child is currently in Year 10 or 11, please list the subjects that they are studying at their current school and, if known, the level of those subjects, e.g. BTEC, GCSE etc: + Section 3 - Information relating to the child Is your child a Roman Catholic? YesNo Date & Place of Baptism: Place where the child now worships: Priest: Pastor / Vicar: If your child is not Roman Catholic please specify their religion: Can your child speak Welsh? FluentlySpeaks Welsh but not fluentlyNo Does your child speak Welsh at home? YesNo Does your child speak Welsh with: Both parentsOne parentNeither parents What is your child’s first language? What is your child’s home language? National Identity: WelshEnglishScotishIrishBritishOther Please provide information of any health issues your child may suffer from, e.g. Asthma, Hayfever, Other Allergies, Diabetes etc. Please select the ethnicity of the child: ---AlbanianAfghanistaniAfrican AsianArabAsian and BlackAsian and ChineseBangladeshiBlack and ChineseBlack EuropeanBlack North AmericanBosnian HerzogovinianBritish GypsyBulgarianCaribbeanChineseCroatianCzechFrenchGermanGhanaianGreek - Greek CypriotGypsy – Gypsy RomaHong Kong ChineseHungarianIndianInformation RefusedIranianIraqiItalianJapaneseKashmiriKashmiri PakistaniKoreanKosovanKurdishLatin – South AmericanLatvianLebaneseLibyanLithuanianMalayMalaysian ChineseMalteseMirpuri PakistaniMontenegranMoroccanNepaliNew TravellerNigerianOccupational TravellerOther AsianOther BlackOther Black AfricanOther ChineseOther Ethnic GroupOther GypsyOther Mixed BackgroundOther PakistaniOther TravellerOther WhitePolishPolynesianPortugueseRomanianRussianScandinavianSerbianSierra LeonianSingaporean ChineseSinhaleseSlovakianSlovenianSomaliSpanishSri Lankan TamilSudaneseTaiwaneseThaiTraveller of Irish HeritageTurkish – Turkish CypriotUkranianVietnameseWhite BritishWhite and any other Ethnic GroupWhite European OtherWhite and AsianWhite and Black AfricanWhite and Black CaribbeanWhite and ChineseYemeni + Section 4 - Further information about the child's education 1. Does your child have a brother/sister attending Bishop Hedley Catholic High School at the time of this admission application to the school?If yes, please provide the name and date of birth of the brother/sister attending Bishop Hedley Catholic High School YesNo 2. Does your child have any additional learning needs or any other special support needs?Please provide further details in section 5 of the application form if necessary YesNo 3. Has your child had any exclusions from their current (or any other) school, either permanent or fixed term?Please provide further details in section 5 of the application form if necessary YesNo 4. Has your child had any attendance related issues at their current (or any other) school?Please provide further details in section 5 of the application form if necessary YesNo 5. Has your child received any additional support in a previous educational setting?Please provide further details in section 5 of the application form if necessary YesNo 6. Is your child undergoing a Statutory Assessment of Special Educational Needs, or have a Statement of SEN?Please provide further details in section 5 of the application form if necessary YesNo 7. Is your child currently under a Care Order?If yes, please state the name of the corporate parent who has care of the child: YesNo 8. Are there any other agencies involved involved with your child? E.g. Social Services, OT, SALT, Educational Psychologist, MIA, Health etc.Please provide further details in section 5 of the application form if necessary YesNo 9. Is the child currently or previously been a “looked after” child by a Local Authority?If the child is currently “looked after”, please provide further details in section 5 of this application form, including details of the child’s Social Worker YesNo 10. Has your child any compelling medical, educational or social grounds for their admission? E.g. a written recommendation from the Psychological Service, Intake and Assessment or the Health Authority?A written recommendation from the Psychological Service, Intake and Assessment, or the Health Authority will be required in each case clearly outlining why the school is the most suitable school and the difficulties that would be caused by attending another school. This should be attached to this application form. YesNo + Section 5 - Any addition information Please use this page to provide any information which is relevant and supports your application or to add any additional information to the answers given in section 4. Sign I certify that I have read the Application Policy and that the information that I have provided is true to the best of my knowledge/belief and understand that any false or deliberately misleading information provided on this form may render this application invalid and could lead to the withdrawal of an offer of a school place for my child. Where parents knowingly give false information in order to obtain a place for their child(ren) at a particular school to which they would not otherwise be entitled, they may render themselves guilty of an offence under Section 5(b) of the Perjury Act 1911. Any application granted under such circumstances will be withdrawn.