Basildon Tamil School Application Form
Section 1 - Student Details
Student Name
*
First Name
Last Name
Student Date of Birth
*
-
Day
-
Month
Year
Date of Birth
School Year
*
Please Select
Reception
Year 1
Year 2
Year 3
Year 4
Year 5
Year 6
Tamil Level
Please Select
Palar Nilai
Valar Tamil 1
Valar Tamil 2
Valar Tamil 3
Valar Tamil 4
Valar Tamil 5
Valar Tamil 6
Valar Tamil 7
Valar Tamil 8
To be filled by school
Section 2 - Home Address
Address
*
Street Address
Street Address Line 2
City
County
Post Code
Section 3 - Parent / Guardian Details
Father Name
*
First Name
Last Name
Mother Name
*
First Name
Last Name
Father Mobile Number
*
Please enter a valid phone number.
Mother Mobile Number
*
Please enter a valid phone number.
Father Email
*
example@example.com
Mother Email
*
example@example.com
Section 4 - Emergency Contact Details
Note: Please give a contact details other than parents
Contact 1
*
First Name
Last Name
Contact 2
*
First Name
Last Name
Contact 1 Mobile Number
*
Please enter a valid phone number.
Contact 2 Mobile Number
*
Please enter a valid phone number.
Contact 1 Relationship to student
*
Contact 2 Relationship to student
*
Section 5 - Other Details
Allergy Information:
Any Special Needs
Any Other Information
Section 6 - Declaration
Signature
*
Type your name here
Date
*
-
Month
-
Day
Year
Date
Submit
Should be Empty: