Dover Grammar School for Boys
FOCUS
Half-Term Newsletter
| Headteacher's Foreword |
1- 3 |
| New Houses Information Evening |
.4 |
| Business of Enterprise Project... |
.4-5 |
| Modern Languages Department News |
5 |
| Music Department News |
6-7 |
| Sports Department News |
8-10 |
| Forthcoming Computer Courses |
ll |
| The Parents & Friends Association |
12-15 |
This has been a very busy term, with a focus on preparation for examinations. Students have been working hard finalising coursework and revising for their exams, supported by their teachers who have given their time to help and encourage the students.
Our success in sport continues, and the cricket and athletics teams have made an impressive start to the season. There is a full sports report elsewhere in this Focus magazine.
I was very impressed by the presentations prepared by students in Year 10 as part of the Business of Enterprise competition this term. All our Year 10 students were involved, and the best teams went through to the in-school final which was judged by a panel including the Mayor of Dover and several members of the local business community. The winning team, Securotech, led by Sam Cooke, went through to the regional final which took place at Pfizers on 17 May. Their product was innovative and their presentation was well planned. They did not win, but they were a credit to themselves and the school.
The Parents' and Friends' Association are planning a major fund-raising campaign to raise money for an all-weather cricket pitch. They are organising a number of events to launch this campaign, and there is plenty of information about these events elsewhere in this magazine. Please support them if you can. The PFA works very hard for the school, and they need more parents to get involved, either by joining the committee, or by supporting the events they organise.
Business and Enterprise Specialist Status
We have passed the first stage of the assessment process and on 19 May we received a visit from an HMI Inspector to discuss our application. We now await the outcome of the final assessment. We should be able to let you know the result by the end of
June. If we are successful, we will invite you to a special event to celebrate our Specialist Status and to explain how our own pupils will benefit, and how we can help our partner schools and the local community.
Exam Results and Reports
Students in Years 7 - 10 have been taking their school exams over the last few weeks. Examination results will be sent home according to the following schedule:
We expect to receive the SATs results for Year 9 (Science and Maths) and Year 8 (English) towards the end of
July, and these will be sent home as soon as we receive them.
Reports will be prepared ready to discuss with you at our Academic Review Day on 4
July. Please make this a date in your diary. Further details to follow. After your discussions at Academic Review Day, your son's tutor will complete the report and it will be sent home at the end of the term.
Feedback from parents
We value your feedback on all that is happening at Dover Grammar School for Boys. I am enclosing with this Focus magazine a parent questionnaire which I would ask you to complete and return to the school as soon as possible so that we can evaluate your opinions.
There are a number of significant changes taking place in the school between now and September. These are explained below:
Changes in staff responsibilities
Some of these changes have already taken place; others will take full effect in September.
Mr Ralph Mr Nugus Mr Sanders Mrs Saville Mr Jolliffe
Mrs Hargrave Mr Thomas
Mr Morrissey Ms Grilli
Mr Morgan-Smith
Director of School Improvement and Subject Leader for Geography Director of Assessment
joint Subject Leader for Science joint Subject Leader for Science Co-ordinator of Sixth Form Subjects Head of Admissions and Induction Subject Leader for Dramatic Arts Subject Leader for History
Subject Leader for English
Lead teacher for Technology
Mr Davies remains as Director of the Learning Centre and Special Needs Co-ordinator Mr Gaskell (Head of Castle House) is responsible for the 6th form
Dr Cruttenden (Head of Port House) is responsible for Options, Careers, Higher Education and Gifted and Talented students
Dr French (Head of Channel House) is responsible for Special Events
Mr Sanders is responsible for Primary Liaison
Mr Davies and Mr Ralph are responsible for Target GCSE and Target SATs programmes
The new House structure
I recently sent a letter home explaining the changes to our tutor system which will come into effect when we return to school on 5 June. In case you did not receive that letter, this is what it said:
As you know, pupils in Castle House have been involved in a pilot scheme this year. They have been in mixed aged tutor groups for their registration and tutorial time. This has brought a large number of benefits and we are now extending the pilot across the whole school.
Your son will remain in his current House and he will be placed in a tutor group along with students from every year group from Year 7 to Year 13. There will be six tutor groups in each House.
The Heads of House have been appointed. They are:
Castle House Channel House Port House Priory House
Mr Gaskell
Dr French
Dr Cruttenden
Mrs Buckley
Your son's Head of House and tutor will be responsible for monitoring his academic progress. Over the years, as your son moves through the House, he will retain the same tutor, so that the tutor and the Head of House will get to know you and your son well. There will be opportunities for House competitions, and students will be involved in mentoring younger students in their House.
The Heads of House will replace the Heads of Key Stage who will be relinquishing their current Key Stage responsibilities and undertaking other roles within the school.
Your son's lessons will continue as they are at present. The mixed age groups are for registration and tutorial time only.
The new tutor groups are being drawn up at the moment, and next week your son will be informed of his new tutor and classmates. Students in Years 7 - 10 will be registered in their new tutor groups when they return from the Whitsun holiday on 4 June. Year 12 will be integrated when they return from their Study Leave. In September, the new Year 7 and Year 12 students will be integrated into the tutor groups.
There will be special evenings for the students and parents of each House during June. This will be an opportunity for you to meet your son's new tutor and Head of House and to hear of our plans for the new vertical system. We hope you will be able to attend. Full details will be in Focus magazine, which is being sent home by post on 26 May.
There have been a number of internal changes in staff responsibilities, some of which have already taken place, and some of which will take full effect in September. Full details of these changes will be published in Focus magazine.
We are very excited about this new phase in the life of the school and the benefits we believe it will offer your son. We are confident that the new system will improve the support your son receives with his academic progress, and that it will improve our communication with parents. Feedback from those involved in the Castle pilot has been very positive, and we will be asking for some feedback from all our parents once the system is established.
Finally, I would like to thank you for your support this term, and to wish you a pleasant holiday.
| I |
New Houses Information Evenings |
by Mr S Pullen, Deputy Headteacher
The new Heads of House will be holding the following information evenings for parents and students. This will be an opportunity for you to meet your son's new tutor and Head of House and to hear of our plans for the new vertical system.
Castle House Channel House Port House Priory House
Monday 26 June 2006 Tuesday 27 June 2006 Thursday 29 June 2006 Wednesday 21
June 2006
| I |
Business of Enterprise Project |
by Mrs T Buckley, Assistant Headteacher
All Year 10 pupils have taken part in the Business of Enterprise project. This competition is organised by the East Kent Education Business Partnership and is sponsored by The Prince's Trust, Business Link, the Learning & Skills Council and a number of local businesses including Cimmins Power Generation Ltd, Sport by Design, London Fancy Box Company and Girlings Solicitors to name but a few.
All Year 10 worked in groups of up to 8 people. They had to come up with an idea for a product which could be either a new product or a 'twist' on an established product. The project was launched with a 'Masterclass Day' in Dover Town Hall (other competing teams met in equally prestigious locations) where they learned about setting up costs for a business, managing business finances, the importance of market research, advertising and promotion, working in teams and developing innovative ideas.
The group worked with a business mentor who visited the school weekly for approximately six weeks. Some lesson time was devoted to the development of the project and boys were given opportunities to use the school's resources and facilities, including teachers in other departments, during break time and after school. At the end of Term 4 all groups presented their enterprise idea to a panel of judges - Mrs Buckley, Mr Howarth, Mrs Williams (Governor), Daniel Knox (Year 12 student - School Enterprise Co-ordinator), Mrs Crockett and Mr King. Many of the presentations were of such a high standard that it was difficult to choose 6 to go through to the in- school final the next day. Many groups were commended for their ideas and their presentations.
The groups that did win through to the 'i n- school' final included ideas such as a computerised menu board, emergency mobile phone charger and a 'stylus' to tap the keys on a mobile phone. The ideas were presented to a panel of judges including the Mayor of Dover and involved the boys in preparing PowerPoint presentations and prototypes of their products. As well as working out the cost of their product, many groups had researched modern materials and developments in technology to see if their product was feasible.
The winning group - SecuroTech presented their enterprising idea, along with the winners from 17 other schools, to a panel of judges at Pfizer Sandwich on 17th May. The level of
competition was high and our team acquitted themselves very well against teams from schools who have been entering this competition for a number of years. Next year SecuroTech will be able to pass on the benefit of their experience to the winning team.
We will definitely enter next year! The boys have gained a tremendous number of skills from the activities they have taken part in - team building, problem solving, working together, creativity, presentational skills, public speaking - the list goes on ... and that does not include the Business, ICT & Mathematically related skills.
This project gave excellent opportunities for the development of enterprising, innovative and creative learning at DGSB.
by Mr S M Almond, Subject Leader for Art
We have been informed by Kent County Council's Arts Events Department that one of our pupils,
Jake Willson of Year 13, has been awarded a Gold Medal in this year's prestigious john Downton Awards Exhibition for Young Artists, held at County Hall, Maidstone.
Jake's colourful painting of two generations of his family was praised very highly by the judges.
Jake has added to our past success in this major competition, open to all secondary schools in Kent, following the Bronze Medal won by Neil Brinicombe in 2001.
Jake will be receiving a certificate and a large cash prize. We have been told that our other two entries were both exhibited large colourful landscapes by Daniel Philpott (Year 13) and
James Sherred (Year 12). Very well done to all our exhibitors!
| I |
Modern Languages Department News |
by Mrs F Lloyd, Subject Leader for Modern Foreign Languages
We are looking forward to our combined visit to the Black Forest and Strasbourg and will tell you all about it on our return.
Well done to all MFL Year 11 and 13 candidates who valiantly took all their oral examinations.
With the World Cup taking place in Germany, could we ask that if you have any material in German you may not need, it is sent to us to use in lessons and for display. Thank you
Help with Modern Foreign Languages in L8
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German Mondays at 1.00pm
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French Tuesdays at 1.00pm
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German KS3 Fridays at 1.00pm
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If you have any 'redundant' French or German dictionaries at home, could you |
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please perhaps donate them to the Modern Foreign Languages department. |
by Mr P H Baldock, Director of Music
Two of DGSB's musicians were represented at this year's Dover Young Musician of the Year organised by Dover Rotary Club. The final, held in Dover Town Hall took place on Saturday 25 March. Miles Brett in Year 13, performing challenging concerto repertoire for the violin, was unlucky to come second in the competition for the second year running and Year 12 student Michael Schlamm achieved joint third place with his performance of a major work for viola by Schubert. The Young Musician of the Year is a worthwhile competition which attracts considerable interest in the area. Over 250 people attended the final in Dover Town Hall and many students from local schools entered the competition. I would like to congratulate Miles and Michael on their achievements. It was a great pleasure to hear the two students perform with musicianship, confidence and maturity.
The DGSB Big Band, String Ensemble, junior Wind Band and Training Strings were joined by soloists to present the annual Spring Concert in the School Hall on Wednesday 26 April at 7:30 pm. Once again, this event was well attended and in addition to the ensemble items, the audience were treated to solos performed by students on a variety of instruments including violin, viola, cello, double bass, saxophone, clarinet and piano. The String Ensemble which comprises both students and staff of the school performed two challenging works from the classical repertoire for string orchestra. The ensemble was joined by Stephen Yarrow (solo organ) and Miles Brett (solo violin) in a performance of Albinoni's popular Adagio for Organ and Strings and the ensemble also gave a performance of movements from the Capriol Suite by Peter Warlock. The junior Wind Band performed arrangements of themes from Dr Who and Star Wars and the concert began with three traditional songs performed by the Training Strings directed by Mrs Sue Morgan. The concert concluded, as is traditional, with polished performances of repertoire for swing band performed by the DGSB Big Band under their director Mr Bryan Shaw. The standard of music making at this concert was very high and all students and staff who took part are to be congratulated on their commitment to the school's music.
A week later on 3 May, A Level music students presented their assessed performances and recitals at the new recording studio at St Edmund's Catholic School. Twenty minute recitals were performed by Year 13 students Miles Brett (Violin) and
Jake Willson (Electric Guitar). These performances were of an extremely high standard and the recorded quality of the work we hope will impress the A Level Examiners. Both students are going on to study music further after their A Levels have been completed.
Jake has won a place to study guitar at the world famous Berklee College of Music, located in Boston. Berklee is the world's largest independent music college and the premier institution for the study of contemporary music. Miles has been offered the chance to read music at The University of Leeds, an institution with an excellent music tradition, which will enable him to develop his range of musical skills and interests, including performing and conducting.
AS and A2 composition students have benefited recently from working with a professional composer with a view to the student works being performed as part of the Deal Summer Music Festival. These innovative workshops were initiated as part of the Festival's educational outreach and we are very grateful to the Festival committee for enabling our school to be involved. The student compositions will be performed as part of a String Quartet Day taking place on Wednesday 5
July. For more information on this and other concerts visit the Deal Summer Music Festival's website at
www.dealfestival.co.uk
On Thursday 29 June at 7:30 pm we will be presenting another concert of music in a variety of styles by guitar students and staff of the school. These concerts give performing opportunities to the large number of boys taking guitar lessons at the school. The programme will include pop, rock and classical guitar music and will be set up and supported by the music department's guitar teachers. Teachers will be performing with students on the night and the evening will take the form of a formal concert with programmes.
Congratulations to the following students who were successful in recent Grade Examinations:
|
Benjamin Bancroft |
Clarinet |
Grade 1 |
Merit |
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Philip Martin |
Alto Saxophone |
Grade 2 |
Merit |
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James Dawkins |
Double Bass |
Grade 2 |
Merit |
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Matthew Hunt |
Drum Kit |
Grade 2 |
Merit |
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Matthew Curtis |
Clarinet |
Grade 3 |
Pass |
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Scott Wright |
Clarinet |
Grade 3 |
Pass |
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Connor Lawrence |
Drum Kit |
Grade 3 |
Merit |
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Freddie Reay |
Alto Saxophone |
Grade 4 |
Pass |
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Connor Lehan-Finn |
Drum Kit |
Grade 4 |
Honours |
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Richard King |
Drum Kit |
Grade 4 |
Merit |
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Michael McKenzie |
Snare Drum |
Grade 4 |
Honours |
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Visar Beqiri |
Alto Saxophone |
Grade 5 |
Pass |
Forthcoming Musical Event
Thursday 29 June 7:30 pm School Hall
by Mr S A White, Subject Leader for Physical Education
Rugby
Congratulations to the Year 11 and 10 rugby teams for winning the East Kent Championships in March/April. Both teams played extremely well against tough opposition in, at times, atrocious conditions.
Special mention must go to the Year 11 team who convincingly won every game throughout the championship. The nucleus of this team will be continuing their education at DGSB next year therefore strengthening the 1" XV further.
Summary of final placings:
Year 7 Year 8 Year 9 Year 10 Year 11
3'd Runners-up 3'd
Winners Winners
District Champions and an outstanding English Schools Total
As we approach the final term of the year, the athletics season is well under way. The enthusiasm shown by all boys in lesson times and at lunchtime clubs has greatly impressed the PE department, making our job of picking teams extremely difficult!
We have competed in two major meetings so far producing excellent results in all three.
District Championships:
Held at the wonderful Julie Rose Stadium, Ashford in the second week of May DGSB sent out two strong squads with the aim of completing a 'double' by winning both the junior
boys (years 8 and 9) and Intermediate Boys (years 10 and 11) competitions.1
In extremely warm weather (which is great for sunbathers but testing for 1500m runners!) all boys performed exceptionally well with a number of them posting personal bests. The Intermediate boys consisting of a core of powerful year 10 athletes won the first track event and never looked back from there. A string of fine performances throughout the afternoon resulted in 1" place and a healthy 10-point winning margin from arch rivals Duke of York School.
The Intermediate Boys team consisted of: (individual event winners in bold)
Dan Robinson, Oliver English, Adam Hall (Year 11), Daniel Allen, Sam Douglas, Ryan Doble, Michael Kelly, Dale Mercer, Jack Staley (Year 10)
Alas the 'double' was never achieved as our junior Boys agonisingly lost by a single point to Sir Roger Manwood's School. However, all boys can be extremely proud of this achievement and can look forward to having another attempt at the title next year.
The junior Boys team consisted of: (individual event winners in bold)
Craig Andrews, Joe Lansdowne, Max Minus, Andrew Reet, Warren Uden, Adam Hurford,
Jacob C1apson, Dan Young, Sheridan Martin, Craig Knowles (all year 9)
Sainsbury's English Schools Athletics Competition Round 1:
Having achieved victory at this stage last year DGSB were placed in a much tougher group
| in this national competition. Two teams of 14 athletes recently travelled........ |
to |
Dartford to take on some very strong North Kent teams. With the
scoring based on performance and not placings, it was vital that every ~
boy gave his all for that extra second or centimetre.
However the total of 410 points achieved by the Intermediate Boys team (years 9 and 10) was extremely good, to the extent that it was at least 40
points greater than any DGSB team has managed to achieve in this competition before! Unfortunately such was the calibre of Ravenswood (422 points) and BETHS
Grammar (421) points that we narrowly missed out on 1st place.
Once again the level of effort shown was outstanding, but it was not to be our day as both teams failed to accumulate enough points to progress to the regional finals.
Once again this Intermediate team comprised largely of year 10 athletes who will be too old to compete next year, so hopefully our year 9 athletes can build upon the potential they have shown so far this season.
Intermediate Team: Daniel Allen, Sam Douglas, Ryan Doble, Michael Kelly, Dale Mercer,
Jack Staley, Elliot Brown,
Jack Knight (year 10), Visar Beqiri, Jacob Clapson, Craig Knowles, Andrew Reet, Warren Uden, and Dan Young (year 9)
With regards to the junior Team (consisting of a mixture of year 7 and 8 boys) a final placing of 6th is somewhat harsh considering the excellent effort they all applied.
Junior Team: Elliot Bullock, Matthew Game, Dan Coleman,
James Golding, Hamish Jerden, Alex Dudfield, James Roushas, Connor Speed,
Jordan Hammond (year 8), Shane Gillman, Kieran Reilly, Sam Woodard, Jon Mummery (year 7)
Sports Day
Sports Day will be held on Monday 10th July this year. It is traditionally a wonderful occasion where all boys can demonstrate their athletic prowess in a number of track and field events. Naturally, family and friends are welcome to lend their support. Further details will be posted nearer the time.
Cricket Year 7
The Year 7 cricket team started the season with a bang by winning their first game against The Marlowe Academy in the Kent Cup by six wickets with some impressive individual performances. The team then played their second match of the season against a strong Harvey Grammar School in a friendly. Despite being defeated the team still performed well and have shown a lot of potential for the future. The next round of the Kent Cup will see the
boys pitting their wits against Chatham House Grammar School from Ramsgate in the first week of Term 6. We are hopeful of a positive result in this game and further progress in the Cup.
Year 8
The Year 8 cricket team have only played one game so far this season, progressing through to the second round of the Kent Cup with a comfortable 8 wicket victory against Walmer Science College. The performance was a very strong one and gives very encouraging signs for the remainder of the season. By the time you read this, the team would have played their second game of the season against Harvey Grammar School in a friendly. Once again we
are hopeful of a positive result.
Year 9
Due to the unpredictable British summer and new Kent Cup group format at U14 level this year, the Year 9 team are yet to take to the field. However, with friendlies against Harvey Grammar and Sir Roger
Manwoods Grammar lined up for the near future, added to Cup games against Chatham House Grammar and Castle Community College the team will be in for a hectic period of games, where we hope they will be very successful.
Year 10
The Year 10 team have taken to the field only once so far this year and was unfortunate to be drawn against a very strong King's School, Canterbury in the first round of the Kent Cup. Although the boys were defeated they performed very well and all gave 100%. Due to internal exams and work experience this is the only game the team has played so far. However they are due to meet both Harvey Grammar and Sir Roger Manwoods Grammar at the beginning of term 6.
Cricket Nets
Thanks to a generous donation of £400 from the PFA Association the cricketers of DGSB will shortly have brand new cricket nets to practice in on the upper field.
Artificial Cricket Wicket
Having failed to gain funding from the Lord Taverner's Association the proposed installation of an artificial cricket wicket on the lower field has had to be postponed until next year. However, the good news is that the PFA and Old Pharosians Association have agreed to assist in the funding for the wicket. This is fantastic news, which will ultimately improve both the standard and profile of DGSB cricket.
Our sincere thanks go to both of these parties.
U14 District Football
Several members of the year 9 football team represented DGSB at district level this season and helped the team become Kent Champions. Having fought through a tough group, the side managed to beat Medway 3-2 in the semi-finals and went onto beat St Augustines 2-0 in a final held at the end of April. Congratulations to the following boys who represented this side, as well as all other boys throughout the school who represented their district sides this season:
Conor Wynne, Tom Neill, Jamie Capon, George Mortley, Connor Fulluto, Andy Reet, Dan Young and Mitch Parsons
Forthcoming Computer Courses
Some parents have contacted us in response to our previous advertisement concerning ICT courses for parents, carers and members of the community. We are planning to run some of these courses in the near future. If you have not yet contacted us but would like to know more about the computer courses we are offering, then please contact us as soon as possible.
We are aiming to offer a range of computer based courses starting from the absolute beginner to the more advanced - sky's the limit!!
Contact us
Telephone - 01304 206117 - leave a message for Mrs Buckley
Write your suggestions and ask your son to deliver - OR POST! to Mrs Buckley at DGSB. Email tbirchley@dovergramboys.kent.sch.uk
Your comments and suggestions will make this happen. We need to hear from you.
Are you eligible to claim free school meals?
From 6 April 2006, there will be a change to the income 'threshold', which forms part of the 'Tax Credit' free school meal eligibility category. The new threshold figure will be £14,155.
Children whose parents receive the following support payments are also entitled to receive free school meals:
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Income Support (IS);
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Income Based jobseekers Allowance (IBJSA);
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Support under part VI of the Immigration and Asylum Act 1999;
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Child Tax Credit, provided they are not entitled to Working Tax Credit and have an annual income (as assessed by Her Majesty's Revenue and Customs) that as of 6 April 2006 does not exceed £14,155; and
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The Guarantee element of State Pension Credit.
Children who receive IS or IBJSA in their own right are also entitled to receive free school meals.
If you have any enquiries, please contact the school for further information.
The Parents & Friends Association
Chairman
Vice Chairman Treasurer
200 Club
Second Hand Uniform Secretary
Joan Gambrell Sally Lees
Chris Kellers
Dawn Kellers Christine Neilson Diane West
Tel: 01303 221167 Tel: 01304360074 Tel: 01304820335
We would like to thank everyone who came to our Salsa Dance Night. Despite a lack of ticket sales it was a real success and very enjoyable. After speaking to a few parents it seems many were not informed about the evening. We did put a reply form in the last Focus magazine but you may not have received that. I found my Focus magazine screwed up in my son's pocket! We have funded the postage of the Focus magazine this time so hopefully you can join us at the enclosed events. If you would like to receive PFA News by email please reply to d.west@protecdesign.ltd.uk.
We have recently helped fund projects for the Learning Centre, Latin Department and Music Department. We are starting a new fund-raising campaign this year to raise approximately £6,000 for a new artificial cricket square and have donated funds towards new cricket netting. To start the new fund-raising off, we have enclosed a booklet of tickets for our Grand Summer Draw, which will be held on 10 July 2006 at the end of Sports Day. If you need any extra raffle booklets, please complete the slip at the end of Focus and return to the school office.
Our next event is the DGSB Ball to be held in conjunction with the Sixth Form leavers. We are also organising a trip to Faversham Brewery on Saturday 2 September 2006. Look out for our forthcoming events, which we are planning for the Autumn Term: Race Night, Fireworks and BBQ.
If you would like to come and help at any events please contact Diane West on 01304 820335. You are all welcome to come to our committee meeting on 20 June 2006, 7:15 in the School Library. We always welcome new ideas and offers of help.
Please come and join us for a Bucks Fizz Reception
The cost is £20.00 per head to include Self Service Buffet
Posh Frocks - No Stilettos and No Jeans please
Please contact Elaine Keen on 01304216070 for further details.
Reserve your tickets as soon as possible as places will be limited.'
| Please find the booking form at the end of Focus |
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Saturday 2 September 2006
The cost is £10.00 per head to include travel both ways and a tour of the Brewery.
There is a hop festival and craft fair on this day, which you will be free to visit after the tour.
To leave Dover at 11am and return at 6pm - to be confirmed at a later date.
Please contact Elaine Keen on 01304216070 for further details.
Reserve your tickets as soon as possible as places will be limited.
Please find the booking form at the end of Focus.
Extra tickets for Grand Summer Draw - 10 July 2006
| I would like |
00. Grand Summer Draw booklets. |
| Parent / Guardian of: |
Form: |
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Tickets for DGSB Summer Dance - 15 July 2006
Please return to the school office, marked 'DGSB Summer Dance 2006' for the attention of PFA. Buy tickets as soon as possible to avoid disappointment, as numbers are limited.
| I would like |
00. tickets @ £20.00 each. |
| I enclose my cheque (made payable to the PFA) for £ |
. |
| Parent / Guardian of: |
Form: |
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