Leaver's Form - Burlington Junior School

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Please complete this form as soon as possible.

Please note: if you are unable to give a new address, please ensure that you leave a forwarding email address. If you have moved area and do not yet know your child's new school please write unknown.

Thank you.

Child's name *

Date of birth *

YYYY

Year group *

Year 3

Year 4

Year 5

Year 6

Required

Class *

Name of parent *

Parent phone number *

Parent email address *

Date of leaving Burlington Junior School *

YYYY

Name of new school or indicate if being home schooled *

Address of new school (if not home schooled please write N/A) *

Phone number of new school

Start date at new school *

New home address if applicable

Start date at new address if applicable

YYYY

Destination country if applicable

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