Charles Dickens Scholarship Registration Form

Child's Details

Name *

First

Last

Sex *

Date of Birth *

Nationality *

Name of Current School and Address *

Does your child have any medical condition (including allergies), a physical or sensory need, learning difficulties, emotional or mental health need? *

Yes
No

Please provide us with details:

Parent Details

Title *

Name *

First

Last

Occupation

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Email Address *

Home Telephone

Mobile Telephone *

Click Below To Add Second Parent Details

Add Second Parent Details

Add Second Parent Details

Title

Name

First

Last

Occupation

Address (If different from first parent)

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Email Address

Home Telephone

Mobile Telephone

Additional Details

Please mention here the names of any other members of the family attending the School or registered for entry; or any other connection with the School:

Please say how you heard about the Charles Dickens Scholarship Award

Other, Please specify

PLEASE READ THE BELOW DECLARATION AND THEN PRESS SUBMIT TO PROCEED TO PAYMENT IF YOU ACCEPT THE DECLARATION. PLEASE NOTE YOUR CHILD WILL BE REGISTERED ON COMPLETION OF PAYMENT.

We request that our above-named child be registered for the Charles Dickens Scholarship Award 2025 and that we will make the non-refundable registration fee of £50 once prompted. We understand that whether or not a Scholarship is awarded, along with the level of any award offered, is at the sole discretion of the School and that there is no right to appeal or challenge the decision of the School. We understand that the School is unable to return our child’s examination papers or share scores, thresholds or rank order with us. We understand that the terms and conditions of the School will undergo reasonable changes from time to time as circumstances require and will apply in all our dealings with the School. We understand also that the School (through the Head, as person responsible) may obtain, process and hold personal information about our child and, sensitive information such as medical details, and we consent to this for the purposes of assessment and, if a place is later offered, in order to safeguard and promote the welfare of the child. I have read and agree to the above declaration. *

I have read and agree to the above declaration

The school will process personal data about you and your child in accordance with the Data Protection Act 1998 (as amended or superseded, including from 25 May 2018 the general data protection regulation) and other related legislation. We will process such personal data: (i) As set out in the School’s standard Terms and Conditions as are in force from time to time, and in the school’s ‘Data Protection Notice’ which is available on the school’s website as may be amended from time to time; (ii) In order to comply with any court order, request from or referral to an appropriate authority, or legal, regulatory or good practice requirement; and (iii) Where otherwise reasonable necessary for the school’s purposes Please Note: Your data will not be used for any marketing purposes unless you provide explicit consent in the section below.

I have read and agree to the above data notice protection

GDPR Agreement *

I consent to having this website store my submitted information so they can respond to my enquiry.

Email *