39023 BS Senior Girls App Form as singles.indd

Bolton School Girls’ Division – Application Form (Years 7-11)
Application Form
Please complete this form in Capitals
Year of entry: 11+ Years (Yr 7)
12+ Years (Yr 8)
13+ Years (Yr 9)
14+ Years (Yr 10)
15+ Years (Yr 11)
Date of entry: ........................................................................... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Pupil’s Surname/Family name: ....................................... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Pupil’s Forename(s) in full: ............................................... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Pupil’s commonly used name: .......................................... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Date of birth: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . .
Pupil’s nationality: .... ............................................................ . . . . . . . . . . . .
For a child whose nationality is non-European, please indicate if you may require the School to sponsor your child for visa/
immigration purposes: Y/N (Please note that the School reserves full discretion over any decision whether or not to sponsor your
child).
Pupil’s first language(s): ...................................................... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Does the pupil hold a British Passport? Y/N
Passport number (if held): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Expiry Date. . . . . . . . . . . . . . . . . . . . . . . .
Pupil’s normal home address: ........................................... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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Postcode: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Telephone number: .. .......................................................... Family email address: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
First parent’s/guardian’s name, including title: ....... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
If you are not the child’s parent, please specify your relationship to the child: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Occupation & employer: ................................... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Contact details:
Telephone number (if different from pupil’s number above): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Mobile number: .................................................... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Email address (if different from pupil’s address above): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Address (if different from pupil’s address above): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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Second parent’s/guardian’s name, including title:
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If you are not the child’s parent, please specify your relationship to the child: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Occupation & employer: ................................... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Contact details:
Telephone number (if different from above): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Mobile number (if different from above): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Email address (if different from above): .... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Address (if different from pupil’s address above): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
....................................................................................... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
If parents are separated, who has legal custody of the child?
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Please note that all correspondence will be addressed to both parents; if this is inappropriate, please specify.
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Please advise the Headteacher at the pupil’s current school that you are applying for a place at Bolton School; a
reference will be requested upon receipt of this application form.
Current School: ...................................................................... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Current School Year (eg Yr 6): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Date of admission to current school: ............................ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Name of Headteacher: ........................................................ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
School address with postcode: ......................................... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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School telephone number: ................................................. . . . . . . . . . Headteacher’s email address: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Name, address and dates of any other school(s) attended: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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Has the pupil been previously assessed at Bolton School, including Hesketh House Junior Girls’ School/Beech House
Infant School? Y/N
If yes, please give date and details: ................................. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Please mention here the names of any other members of the family currently attending the School or applying for
entry as well as any other connection with the School, past or present:
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Please give details of any specific learning difficulties, special educational needs or disabilities. Please submit a copy
of any SEN reports previously obtained with your completed application form. Please note that all diagnosed
SEND issues requiring additional support or access arrangements must be disclosed at point of application so that the
necessary provision can be put in place for the Entrance Testing Day.
Please give details of any medical problems/conditions of which the school should be aware: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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Please give details of any specific family circumstances you would like us to take in to account: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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To which other schools do you intend to apply or have applied already?
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Is Bolton School your first choice: Y/N
Have you or your daughter attended an Open Morning or Taster Day at Bolton School?: Y/N
If yes, please give details: .................................................... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . .
If you have any other children of school age, which school(s) are they currently attending?
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Please say how you heard of the School: was it from local reputation/current school/friends/advertisements/press coverage/
internet/other (please give details)?:
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Bursaries and Scholarships
We provide a limited number of means-tested Bursaries to offer to pupils entering in Year 7 only. These are awarded in
order of academic merit following the Entrance Testing Day and Entrance Interviews and then assessed according to
family income. Full details are available on the following pages of the website: www.boltonschool.org/bursaries.
Please indicate if you wish to apply for a means-tested Bursary and your family income falls within the levels at which
bursarial support is offered : Y/N
If you answer Yes to the question above, you will receive the form FG1 which should be completed and returned to
Bolton School Girls’ Division – Application Form (Years 7-11)
School as soon as possible and no later than the morning of the Entrance Testing Day. Please note that we are unable
to consider any requests for bursarial assistance after this date.
In addition to the Bursarial support which we offer, we currently provide a small number of non-means tested
Scholarships to offer to pupils entering in Year 7 only. These are awarded in order of academic merit following
the Entrance Testing Day and Entrance Interviews to those girls who are judged most likely to make a positive
contribution to the wider life of the School. Full details are available at: www.boltonschool.org/scholarships
Parents of girls who wish to apply for a Scholarship should complete the following information:
Daughter’s favourite subject(s) at School:
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Hobbies and Interests: ........................................................ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Achievements: Musical examinations passed, inc with Merit/Distinction: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Drama/Speaking examinations passed: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Dance examinations passed: ........... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Sporting achievements: ..................... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Other: ....................................................... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Girls who wish to apply for a Scholarship are advised to read some or all of the Recommended Books, listed on the
website on the following page: www.boltonschool.org/readinglist prior to their Scholarship interview.
Confirmation of Application & Enclosure
We request that the above named child be registered as a prospective pupil. We understand that the standard terms and
conditions of the School will undergo reasonable changes from time to time as circumstances require and will apply in all
our dealings with the School. We certify that fees of the current and any previous school(s) have been paid and consent
to Bolton School making reasonable enquiries thereof. We understand that the School may obtain, process and hold
personal information about the child. We consent to this for the purposes of assessment and, if a place is offered, in order
to safeguard and promote the welfare of the child.
First Signature ............ ............................................................ . . . . . . . . . . . . Second Signature
.........................................................................................
Name in full ............................................................................. . . . . . . . . . . . . Name in full . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Relationship to the child ................................................... . . . . . . . . . . . . . Relationship to the child . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . .
Please note that this form should be signed by all parents having parental responsibility according to the Children Act of 1989.
Please enclose a copy of your daughter’s birth certificate or passport. Please enclose a non-returnable cheque (made
payable to Bolton School) for the registration fee of £40. Please note that we will be unable to process your application form
if the above items are not enclosed.
Please return this form to: Bolton School Girls’ Division, Chorley New Road, Bolton, BL1 4PB.
Please note that payment of this cheque and the completion of the registration form does not guarantee a place at the School, as
admission depends upon a candidate satisfying the School’s current entrance criteria. You are advised to make a copy of this form
before submitting it.
Bolton School Girls’ Division, Chorley New Road, Bolton, BL1 4PB
Tel: 01204 840201 Fax: 01204 434710 e-mail: [email protected] www.boltonschool.org/seniorgirls