iClass Booking Form

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iClass Booking Form

Please provide as much information as possible to enable us to make the best provision we can for the young person whilst they are with us. You will not be able to submit the form unless it is fully completed. If you have any problems or queries, please email us at 'iclass@demeterhouseschool.com' or telephone 01652 225497.

Name of school, setting or authority requesting provision: *

Student's Full Name: *

Date of Birth: *

YYYY

School or setting contact name and email address: *

Home contact name and phone number: *

Are there any other agencies involved with or working to support the young person and/or their family at this time? Please give details below, including contact information. *

Does the young person have any medical needs, allergies or prescribed medication that we need to be aware of? *

Does the young person have SEND needs? Please give as much information as you can to enable us to better meet needs where possible. *

Does the young person have an EHCP? (If yes, please email a copy to 'iclass@demeterhouseschool.com' before the first day of their attendance) *

Yes

What is the young person's current level of working in relation to age related expectations for English and Maths? *

If the young person is in KS4, what are their predicted and/or target grades for English and Maths and which examination boards are they studying for? *

How many days' provision do you require? (Maximum booking of 45 days in any academic year, or 15 days per school term, per student, charged at £150 per day) *

What date do you need provision to start from? *

YYYY

Please accept the following declaration (see www.demeterhouseschool.com for full placement terms): *

I understand that the completion of this form constitutes the booking of a place for the number of days stated above at Demeter House School's iClass provision. I agree that the setting named above will pay, in full, the stated fees for all days booked, whether the student attends or not. Demeter House School reserves the right to refuse admission to any student if their behaviour is deemed dangerous to others or jeopardises other placements, in which case the contract is null and void and we will not be charged for any remaining time. I have the authority to complete this form on behalf of the above named school or setting.

Required

Name of person completing the booking form: *

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