For Office Use: Entry Form: Entry Year:

REGISTRATION FORM
Registration Form (to be completed by parent or guardian)
PLEASE USE BLOCK CAPITALS

Surname of Child First names (in full) Preferred name Date of birth Nationality:

Mahmoud ... Jude ...

Please attach Photo here

...
26/08/1999 ... British ...

Term 1, Year 10 Proposed date of admission (term and year) ...

Languages

nd Arabic and French English (1st) (2 ).

(If English is not the first language, please indicate level of fluency)
Muslim Religion

(It is not mandatory to enter your daughters religion, but it would be helpful if you do)

Parents Details Title Name Address Occupation Nationality Home Tel Work Tel Mobile E-mail Fax

*Father .
Ali Mahmoud . POBox 42450 .

*Mother .
Yousra Shanshal . POBox 42450 .

.
British . 026676393 .

.
British . 026676393 .

.
+971506136542 . ali@qanz.com .

.
+971506176642 . yousra@qanz.com .

*Please indicate preferred contact for correspondence

Full name and address of Guardian, if applicable. (Please note that the appointment of a Guardian is compulsory if both parents are non-UK residents). Guardian Contact Numbers: Home tel . Work tel . Mobile . E-mail . You must attach a copy of your daughters passport and, where applicable, her current visa to the Registration Form. Please indicate the date of renewal of the visa and any information we may need to be aware of regarding your daughters visa status. If your daughter holds a Dependents Visa then copies of the appropriate parents passport and visa are also required. If your daughter requires a Confirmation of Acceptance for Studies (CAS) to join the School you will be required to reimburse the School for the costs of issuing this document.

Please mention here the names of any other members of the family attending the school or registered
None for entry, or any other connection with the school ... British School Al Khubairat, Please state name and address of the present school (with date of entry) September

Name of Headteacher Are there any circumstances relating to your childs health of which the School should be aware? Please tick as appropriate: Allergies Dyslexia Dyspraxia Hearing impairment Visual impairment [ [ [ [ [ ] ] ] ] ]

Other ....................

Declaration We request that the name of the above-named child be registered as a prospective pupil AND we enclose a cheque for the non-refundable Registration Fee of 100.00 (cheques to be made payable to Queens Gate School Trust Limited). We understand that: 1. 2. registration of our child as a prospective pupil does not secure our child a place at the School but does ensure that our child will be considered for selection as a pupil at the school; the School may process personal data about our child, including sensitive personal data such as medical details, for the purpose of administering its list of prospective pupils and administering its selection procedures and we consent to the processing of our childs personal data (including sensitive personal data) for these purposes; in the event that our child is offered a place at the School, such an offer will be subject to the Schools Terms and Conditions for the provision of educational services, which will bind us in the event that we accept the place. Second Signature

3.

First Signature

... . Name in full Relationship to child Date . Name in full . Relationship to child . Date .. .. ..

A copy of the current edition of the standard terms and conditions is available on request.

Queens Gate School, 133 Queens Gate, London SW7 5LE www.queensgate.org.uk