Admissions Fairfield Prep School Please complete and submit the form below. Fields marked * are mandatory. If you wish to apply for more than one candidate please complete the form again. If you have any questions, please call us on +44 (0)1509 215172 or email [email protected] Candidate's DetailsLegal Surname*Legal Forename(s)*Preferred Forename/Known AsDate of Birth*Day12345678910111213141516171819202122232425262728293031Month123456789101112Year20202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Nationality*First Language*Year of Entry*Current Year Group (If applicable)*Gender of CandidateBoyGirlNames of close relatives at, or having attended, Loughborough Schools Foundation, their relationship to candidate and school attended.Year Group Applying For (please tick)*Kindergarten:Full timePart time: 4 daysPart time: 3 daysIf part time is required, please indicate preferred days: Monday Tuesday Wednesday Thursday Friday Year Group:ReceptionYr1Yr2Yr3Yr4Yr5Yr6Preferred start date*Day12345678910111213141516171819202122232425262728293031Month123456789101112Year203320322031203020292028202720262025202420232022202120202019Additional CommentsCurrent School/Nursery DetailsName of Current School/Nursery*Name of Head/Nursery Manager*Address of School/Nursery*Postcode*Email Address* Date Joined Current School*Day12345678910111213141516171819202122232425262728293031Month123456789101112Year20202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Parent/Legal Guardian DetailsParent Legal/Guardian 1Title*Forename(s)*Surname*Relationship to candidate*Address* Street Address Address Line 2 City County Postcode Home Phone*Mobile PhoneEmail Address* Occupation*Employer*Add additional parent/legal guardian? Yes Parent Legal/Guardian 2Title*Forename(s)*Surname*Relationship to candidate*Is your address the same as above? Yes Address* Street Address Address Line 2 City County Postcode Home Phone*Mobile PhoneEmail Address* Occupation*Employer*Where parents have separated or divorced, please state with which parent the candidate resides.Entrance Exam Access ArrangementsA candidate who is eligible may be given an appropriate adjustment in relation to entrance assessments, subject to documentary evidence being provided.Please indicate here if you wish to discuss further. Yes Therefore, if the candidate has had a specialist assessment diagnosing a learning difficulty or disability, for example an educational psychologist's report, medical report, occupational therapist's report, please give brief details on a separate sheet and attach a copy of the most recent report. If the candidate suffers from any medical or physical incapacity of which we should be aware, please five details below.Medical or physical conditionFurther DetailsPlease use this space to provide any further details relative to any matter about which you feel we should be aware.Data ProtectionI understand that information from this form may be processed for purposes by Loughborough Schools Foundation under the Data Protection Act 2018 and that individuals have, on written request, the right of access to personal data held about them. For the purposes of compliance with the Data Protection Act 2018, in completing and submitting this form I hereby give my consent to Loughborough Schools Foundation to process the personal and sensitive data supplied in the Registration Form for the purposes of administering its lists of prospective pupils.* Please tick here to show you have read and understood the above. Registration Fee £50 per candidatePayment can be made either by bank transfer using the following details or by cheque (payable to Loughborough Schools Foundation): Loughborough Schools FoundationCurrent a/c no. 08171610 Sort Code 601410Reference: FDRF and the candidate's surnameBank Transfer I have paid by bank transfer Date payment was madeDay12345678910111213141516171819202122232425262728293031Month123456789101112Year20202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Cheque I have paid by cheque Date cheque was sent or delivered to schoolDay12345678910111213141516171819202122232425262728293031Month123456789101112Year20202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920School emailSchool telephoneCommentsThis field is for validation purposes and should be left unchanged. 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