Child's Details

Child's Name*

First Last

Child's Date of Birth*

Child's Current Year Group*

Gender*

Reason for leaving*

Parent / Carer Contact Information

We are required by the Local Authority to provide an up to date name, phone number and address for the child's primary parent or carer whom they will be living with. If you are moving abroad, where possible, please provide the address of where your family will be living when you have left the UK and a phone number you will be reachable on when you are abroad.

Primary Parent / Carer Name*

First Last

Contact Number*

Address of whom the pupil will be living with*

Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country

Leaver Information

Last day at Heathside*

Name of next School or Nursery*

Address of next School or Nursery*

Street Address Address Line 2 City Post Code Country

Contact Email Address for next School or Nursery*

We are required to contact the child's next School or Nursery to confirm their attendance before we remove the child from the roll at Heathside School Hampstead.

First Day at next School or Nursery*

Deposit Return Form

As your child is leaving Heathside, your deposit will now be returned or transferred.

On reconciliation of your fees account your deposit will be returned less any outstanding charges.

Should your child be moving to another Dukes school, the balance of your deposit will be transferred, unless you instruct us otherwise, and you will receive a statement for any outstanding items on your fees account.

To ensure we have the right transfer information, may I please request that you complete the details below.

Student Name

First Last

If your child is transferring to another Dukes School, please complete this section.

Please transfer my deposit to: (Name of Dukes school)

Bank Details

If your child is not transferring to another Dukes school, please complete this section.

Please return my deposit (less any outstanding charges) to:

Bank Name

Name on Account

Account Number

Sort Code

Please note a representative for Heathside will call to verify your bank account details, as an additional security measure. Payment will be made within 4 weeks after the end of term.

Leaver Information Form

Leaver Information Form

Child's Details

Parent / Carer Contact Information

Leaver Information

Deposit Return Form

Bank Details