Supplementary Information Form If you wish to apply for a place at a

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Supplementary Information Form
If you wish to apply for a place at a Derbyshire voluntary controlled school on
religious grounds, you should ask your Minister, Priest, or Pastor or Religious
leader, if the child is a member of another Christian Church or World Faith, to
complete this form to confirm regular attendance at public worship. Please note
that you must also complete an application form by the closing date of midnight
on 15 January.
Regular worship is defined as attendance at public worship at least once a
month. Where appropriate baptismal certificates should also be supplied.
Further information is available in How to apply for a place at Primary School – a
guide for parents’ at www.derbyshire.gov.uk/admissions
Child’s full name:
Date of Birth:
Preference School(s):
I confirm the above named child’s regular attendance at public worship as
defined above.
Signature:
Name:
Designation:
Church:
Contact Number:
Please return this form to the parents who are required to submit it to the
Admissions and Transport Team, Derbyshire County Council, Council
House, Saltergate, Chesterfield, Derbyshire, S40 1LF by the 15 January
closing date. Any queries relating to this form should be made by emailing
[email protected] or ringing 01629 537479.
'Privacy notice: This information will be used for schools admissions related purposes and may be shared, as the law allows, with partner
organisations. Further details on the Authority's Data Privacy policies and those of partner organisations can be found on the Derbyshire County
Council Websitewww.derbyshire.gov.uk/privacynotices, or a hard copy can be provided on request.