Registration Form

Student Details

Boy's Surname* Christian names* Date of birth* Year for which application is made*

Parent Details

Parent's name Address (line 1)* Address (line 2) Town / City* County Post code* Country Home telephone number Business telephone number Mobile telephone number* Email*

School Details

Name of current school* Next school(s) for which your son has been entered* Proposed date of entry*

Confirmation

I have read the prospectus and would like to enter my son for Cothill House.

If he is admitted I agree to accept the conditions and rules of the school from time to time in force and agree to withdraw my son from Cothill at any time should the Headmaster request me to do so.

Siganture of Parent or Guaridan* Date*

In the case of a Guardian having been appointed by the parents, his or her name, address and telephone number should be given overleaf, together with any information that you might feel relevant to the registration form.

Completion of this form does not bind the parents to send their son to Cothill or the Headmaster to
accept the candidate.