"*" indicates required fields

Child's Full Name*

First Middle Last

Preferred Name

Child's Date of Birth*

Please upload a photograph of your child*

Max. file size: 128 MB.

The photograph will be used to identify your child on our school database.

Year group*

Child's first language:*

Other languages spoken at home (if applicable):

Acceptance Terms

I / We accept the place which has been offered to us for my / our child (named above), on the terms of:

· the letter containing that offer together with any Conditions of Award attached

· this acceptance form

· the School's Terms and Conditions, enclosed with the offer letter

· the School's fees, as varied from time to time.

I / We acknowledge receipt of a copy of the current School rules which I / we have read and have drawn to my / our child's attention.

Cancellation Rights

I / We understand that I / we have the right to cancel this contract at any time within 14 days of the day following the School's receipt of this acceptance form only if the offer is made and accepted entirely at distance by means of post or electronic communication.

Immigration Rights

Where applicable I / we enclose a copy of my / our child's passport and immigration status documentation confirming his / her right to enter the United Kingdom and study at the School. Where he / she holds a dependent visa, I / we also enclose a copy of my / our passport(s) and immigration status documentation confirming my / our right to enter and live in the United Kingdom. Please see clauses 3.5 and 9.14 in the School's Terms and Conditions.

Please upload a copy of your child's passport*

Max. file size: 128 MB.

Nationality*

If not a UK citizen, please upload Visa evidence (BRP card, notice of Leave to Remain, etc.)

Max. file size: 128 MB.

If your child holds a DEPENDENT visa, please upload the passport and Visa evidence (BRP card, notice of Leave to Remain, etc.) of the adult they are a dependent of:

Max. file size: 128 MB.

Additional documents

Upload additional documents

File

Drop files here or

Max. file size: 128 MB.

Declarations by the signatories to this acceptance form

I / We declare as individuals and jointly that:

(1) Terms and conditions: Before signing this acceptance form I / we have read and understood and I / we agree to the School's Terms and Conditions and, where appropriate, the Conditions of Award of a bursary or scholarship, which will undergo reasonable change from time to time. I / We have retained a copy of the School's Terms and Conditions with our records.

(2) Disclosures: I / We have already provided and will continue to provide details of any medical condition, health problem or allergy affecting my / our child; any learning difficulty, disability, or special educational need of my / our child; as well as any behavioural, emotional and / or social difficulty of my / our child (for example dyslexia, dyspraxia, attention deficit disorder, visual or hearing impairment or any condition requiring use of a wheelchair). I / We attach in confidence details of any relevant information received since my / our previous disclosure.

(3) Medical matters: I / We will complete in confidence the School's Medical Information and Consent Form and will continue to provide all relevant information about any medical condition, health problem or allergy which affects my / our child and / or which may prevent my / our child from taking a full part in the School's academic and games or sports curriculum, outdoor activities and educational visits or if my / our child has been in contact with anyone with an infectious or contagious disease.

(4) Court orders: Where I am / we are separated or divorced, I / we have informed the School of this. I / We have also disclosed all court orders or criminal proceedings in relation to my / our child and all court orders, criminal proceedings, statutory demands or bankruptcy petitions relating to either parent (including any court orders relating to financial matters). I / We will disclose any subsequent court orders, criminal proceedings, statutory demands or bankruptcy petitions to the School.

(5) Parental responsibility: I / We both have parental responsibility (i.e. legal responsibility) for the child named above.

To confirm, please select one of the below:*

If any person signing this acceptance form does not have parental responsibility for the child please provide a brief written explanation of the relationship between that person and the child together with the name(s) of all others with parental responsibility for the child.

(6) Current and previous schools: I / We confirm that fees payable to my / our child's current and any previous schools have been paid or will be paid in full before my / our child enters the School. Except as disclosed in a confidential letter attached to this acceptance form, my / our child has not been withdrawn from or been asked to leave another school as a result of misconduct and is not under investigation and has not been convicted of any criminal offence.

(7) School fees: I / We understand that the School may at any time make enquiries of my / our child's current or previous schools for confirmation that all sums due and owing to such school(s) have been paid. I / We understand that the School may inform any other school or educational establishment to which I / we propose sending my / our child if any Fees of this School are unpaid. I / We also understand that the School may make reasonable enquiries of relevant third parties (for example credit reference agencies) about my / our financial means in appropriate circumstances.

(8) Cancellation or Withdrawal: Except where the cancellation rights described above apply or where otherwise provided in the School's Terms and Conditions I / we will not cancel my / our acceptance of this place or withdraw my / our child from the School without first giving a Term's Written Notice or paying a Term's Fees in accordance with the School's Terms and Conditions. Please see Section 9 of the School's Terms and Conditions for further information about Notice, Cancellation and Withdrawal.

(9) Documents: I / We confirm that before signing this acceptance form, I / we have seen or had an opportunity to see all the documents referred to in the School's Terms and Conditions, including the the School rules and procedures.

(10) Confirmation of declarations: I / We confirm that the declarations made on this acceptance form are true and that I / we have disclosed all information required in the declarations. I / we understand and agree that the School has the right to terminate this contract for educational services immediately if any declaration is found to be untrue.

Authorities given by the signatories to this acceptance form

I / We give the following express authorities on behalf of myself / ourselves and (so far as I am / we are entitled to do so) on behalf of my / our child.

(11) Commencement of services: I / We consent to the School providing educational services to my / our child if he / she starts as a pupil at the School within 14 days of the date of this acceptance form.

(12) Educational visits: I / We consent to my / our child taking part in all educational visits and activities which take place off School premises while he / she is a pupil at the School.

(13) Transport: I / We consent to the Pupil travelling by any form of public transport and / or in a motor vehicle driven by a responsible adult who is duly licensed and insured to drive a vehicle of that type.

(14) Dukes Education Group Current School: if applicable, we hereby instruct and consent to the School contacting the Current School to arrange the transfer of the deposit held by them to the School as partial payment or whole of the Application Deposit Fee on our behalf, subject to all outstanding fees with the existing school having been settled in full.

How we use your information

For more information about how the School will use your information, and your child's information, please see our privacy notice.

This document is published on the School's website: https://www.heathsideschoolhampstead.com/privacy-statement

If your child is going to enter Year 7 or above, they have the maturity to exercise their own data protection rights. Therefore please show them a copy of the pupil privacy notice and discuss it with them.

Second emergency contact (if applicable)

If only one person is to sign this acceptance form, the School requires You to complete the details below for a second person who You authorise Us to contact in an emergency.

By signing this acceptance form you confirm that the second emergency contact has agreed to act in that capacity.

Do you need to provide a Second Emergency Contact?*

Name*

First Last

Address*

Street Address Address Line 2 City ZIP / Postal Code Country

Relationship to child*

Emergency contact telephone number*

Signatures

Upon completion of this form, I / We will pay by bank transfer direct to the School's bank accout the amount stated in the Offer Letter, being (a) the Application Deposit Fee in full or (b) the balance of the Application Deposit Fee (following transfer of the existing deposit held by a Dukes Education School) due which will be held without payment of interest in the general account of the School in accordance with the School's Terms and Conditions referred to above. The Acceptance Deposit will be held without payment of interest in the general account of the School in accordance with the School's Terms and Conditions referred to above.

First signatory

First*

Prefix First Last

Relationship to child*

Phone*

Email*

Emergency contact telephone number

(if different)

Address*

Street Address Address Line 2 City ZIP / Postal Code Country

Signature*

Date*

Second Signatory

First

Prefix First Last

Relationship to child

Phone

Emergency contact telephone number

(if different)

Address

Same as First Signatory

Address

Street Address Address Line 2 City ZIP / Postal Code Country

Signature

Date

Offer Acceptance Form

Acceptance Terms

Cancellation Rights

Immigration Rights

Declarations by the signatories to this acceptance form

Authorities given by the signatories to this acceptance form

How we use your information

Second emergency contact (if applicable)

Signatures

First signatory

Second Signatory