Registration Form

Your daughter
Surname/Family Name*
Forename/First name*
Preferred name (if different)
Date of Birth*
Date Format: DD slash MM slash YYYY
Nationality*
Proposed date of entry
Proposed level of entry
Would like to apply for deferred entry (Year 9 applicants only)
Type of place:
Have you registered your daughter at any other school(s) and if so, which?
Co-curricular
Please outline any artistic, dramatic, musical or sporting skills and any hobbies/interests.
Health
Please provide details of any medical condition, health problem, disability, allergy or behavioural, emotional or social difficulty affecting your daughter.

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Parent 1/Guardian’s details
Title
Surname/Family Name
Forename/First name
Address Address Line 2 City Post Code
Mobile
Home Tel. No
Work Tel. No
Email
Occupation
Parent 2/Guardian’s details
Title
Surname/Family Name
Forename/First name
Address Address Line 2 City Post Code
Mobile
Home Tel. No
Work Tel. No
Email
Occupation
Divorced/Separated - In the case of divorced or separated parents, please state your daughter’s main residence
Please provide details below

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Other people with parental responsibility
Title
Surname/Family Name
Forename/First name
Relationship to Applicant
Address Address Line 2 City Post Code
Mobile
Home Tel. No
Work Tel. No
Email
Occupation
Connections with the School
Please mention here the names of any other members of the family attending the School or registered for entry, or any other connection with the School.
Please indicate how you first heard of the School
Please provide details below

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If you have indicated that your daughter is a national resident of a country outside the EEA, or if you have provided a home address for correspondence outside the EEA, please note that the School is required to take steps to ascertain that your daughter has permission to be in the UK.
Please confirm whether your daughter will require child student sponsorship from the School in order to obtain a visa to study in the UK at this School.
- Yes
- No
If another valid immigration category applies to your daughter please provide full details below
If your daughter has or will have a time restricted or temporary visa in any other immigration category (for example, as a dependent) please provide a copy of this when returning this form. Please note that we will be unable to process your registration until such copy documentation is provided.
Please note that we reserve the right to:
a) request further information and sight of documentation in support of your declarations regarding immigration; and
b) share information with UK Visas and Immigration (UKVI) and the Home Office for the purposes of compliance with our responsibilities as a licenced sponsor.

By completing this registration form you hereby consent to our notifying and/or supplying information relating to your (i.e. the parents) and/or your daughter’s right to enter, reside and/or study in the United Kingdom to UKVI and the Home Office (and to do so whether we sponsor your daughter or not).
Declaration
Registration does not secure a place at the School. Offers of places are subject to availability and the admission requirements of the School at the time offers are made. A copy of the School’s Terms and Conditions will be supplied on request.

If you would like further information about how the School processes personal information, please see our Data Protection and Privacy Policies.

I/We request that our daughter named above is registered as a prospective pupil

I/We understand that the School may obtain, process and hold personal information about me/us which may include financial information provided by me/us or by any licensed credit reference agency or information contained in any court orders, petitions or proceedings.

I/We understand that the School may also obtain, process and hold personal information about our child which may include sensitive information such as medical details, for the purposes of assessment and, if a place is later offered, in order to safeguard and promote the welfare of the child.
- I agree to these terms and conditions
Registration
Please upload a copy of her passport
Accepted file types: jpg, gif, png, pdf.
Payment
- I/We have paid the non-refundable Registration Fee of £200 by bank transfer/flywire
Bank transfers:
Barclays Bank Account: 60459690, Sort Code: 20-02-87

International payments:
Payment to be made on-line via https://www.flywire.com/pay/heathfieldschool
Email
This field is for validation purposes and should be left unchanged.

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Step 1 of 5

Your daughter

Co-curricular

Health

Parent 1/Guardian’s details

Parent 2/Guardian’s details

Other people with parental responsibility

Connections with the School

Specific Learning Difficulties

Ethnicity

Current School

Declaration

Registration

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