Pupil First Namerequired

Pupil Last Namerequired

I confirm that I would like to gift part or all of my acceptance deposit to the Wellington School 1972 Bursary Fund, in line with the instructions below:

Full Deposit

Yes No

Balance of Deposit (After Charges)

Yes No

Specific Amount

Yes No

Specific Amount

To confirm and authorise your deposit please fill out the details below:

Parent First Namerequired

Parent Last Namerequired

Date required (dd/mm/yyyy)