Application for Entry

I am applying for my child to join:* Year of Entry:*

Pupil Basic Details

Pupil Surname:* Pupil Forename:* Pupil Middle Name/s: Pupil Preferred Forename: Pupil Date of birth:* Pupil Gender* Pupil Address (line 1)* Address (line 2) Town / City* Postcode*

Parent / Guardian Details

Parent /Guardian 1 Title* Parent/Guardian 1 Forename:* Parent/Guardian 1 Surname:* Parent/Guardian 1 Gender:* Relationship to Pupil* Parent/Guardian 2 Title: Parent/Guardian 2 Forename: Parent/Guardian 2 Surname: Parent/Guardian 2 Gender: Relationship to Pupil

Contact

For separated parents only, please indicate with whom child is living:

	Parent/Guardian 1	Parent/Guardian 2
Mobile
Telephone (Home)
Telephone (Work)
Email
Occupation
Religious denomination
Nationality

Family connections with the School (if any):

Previous Education

Name & full postal address of your most recent school (A reference will be requested): Name of Head: Month and year of entering Leaving: Please confirm whether your child will require sponsorship from the school in order to obtain a visa to study in the United Kingdom at this school* Please indicate below any major achievements (academic, sporting, musical, dramatic or artistic) either at school or outside school

	1	2	3
academic
sporting
musical
dramatic
artistic

Please indicate whether your child has any medical condition, health problem or allergy and/or any learning difficulty, disability or special educational need, as well as any behavioural, emotional and/or social difficulty. If so, please complete and return the Confidential Information form, which can be found on our website under Admissions/Application Enquiries.

Financial Assistance

Please note that scholarships or bursaries are only available from 11 .

If you wish your child to be considered for a scholarship, please tick the relevant box*MusicArtAcademic Scholarship

Please indicate how you first heard of Leicester Grammar School:*

If you wish to be considered for the award of a means tested bursary place.*NoYes

Payment

I enclose the registration fee of £75:00 (non-refundable) (cheques to be made payable to LEICESTER GRAMMAR SCHOOL)*

Alternatively

Use the link below to make an online payment for the non-returnable registration fee of £75 and a copy of the named child's full birth certificate uploaded below.

Registration Fee Payment Link

I have transferred the registration fee of £75:00 (non-refundable, LGS Trust, Account No: 34324690

Sort Code: 56-00-55 using my child’s name as the payment reference)*Please tick

I upload a copy of the Pupil's Birth Certificate*Please tick

Upload Birth Certificate No file chosen

For non-EU candidates the registration fee is £300 (non-refundable) plus a deposit of one full term’s fees which will cover text books, non-residential trips etc. The balance of any amount remaining will be returned at the end of the course.

Declaration Agreement*Please tick this box to accept terms above.

Date

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

Leicester Grammar School

Leicester Grammar School Trust