Mid - Year Application Form

You should not remove your child from their current school until a place has been secured at Rodings or another school.

Section 1 - Pupil Details

Pupil Surname:* First Name:* Date of Birth:* Year Group:* Gender:* Current School (or last school attended)* Town and postcode of current school* Is the child still attending? Yes/No* If no, last date of attendance If the child is known by another name please add it here

Section 2 - Home Address

House number or name* Street* Town/Village* Post Town* Postcode*

Section 3 - Parent/Carer Details

Title* Initials* Surname* Relationship to child* Home phone no.* Mobile phone no.* Email address*

Section 4 - Reason for change of school

a) Preferred date of admission* b) If you are moving into the area, date of move

New Address if different to Section 2 (please attach copies of proof of address (e.g. exchnage of contracts or signed tenancy agreement).

House number of name Street Town or village Post Town Postcode Upload relevant documents here No file chosen c) Have you discussed your reasons for wanting a different school for your child with your child's current school? d) Has your child attended any other primary school?

If 'yes' please give details:

Name of school (1) Date of Leaving Reason for leaving Name of school (2) Date of Leaving Reason for Leaving

Section 5 - Other details

Is your child cared for by the Local Authority or is he/she a previously looked after child?* Does the child have an Education Health Care Plan (previously known as a statement?* Are there any exceptional medical reasons why the child should specifically attend this school (in accordance with the school's Admission Policy)? If 'Yes', please attach supporting evidence from the child's doctor or other health care professional Upload any documents here No file chosen

Section 6 - School preference.

Please state your preferred school in the box below. You do not have to give reasons for your preference. Any reason you give should generally refer to the admissions policy.

Preferred school* Reason

Section 7 - Siblings

If you have another child at this school please enter their details below.

Name: Date of birth:

Section 8 - Other Information

Other information:

Section 9 - Declaration

I confirm that the information I have given is true and that I am a parent of this child.

Signed:* Date:*

This form will automatically be sent to Rodings Primary school. If you would like full details on how a school uses personal data, please visit the school website. If you would like full details on how ECC uses personal data, please go to www.essex.gov.uk/privacy or call 03457 430430