Princes Risborough School

PRINCES RISBOROUGH SCHOOL ADMISSION INFORMATION Please complete and return to the Data Manager All schools are required by law to keep on record details of children admitted. The purpose of this form is to collect data for further processing within the school/LEA systems. Your signature on this form implies your consent for the school/LEA to process the data. The data will be processed in accordance with the purposes notified by the school/LEA to the Data Protection Commissioner’s Office and are subject to the Data Protection Act 1998. The information given will be entered onto a computer and will form part of the School’s database. Declaration of person with legal responsibility I declare the information in this booklet to be correct to the best of my knowledge at the time of completion. I agree to notify the school of any change in my child’s circumstances.

PARENT / CARER SIGNATURE…………………………………………………………………………………

STUDENT DETAILS Legal Surname/Family Name: Surname used (if different to Legal Name)

Forename Likes to be called

Middle name/s Gender M / F

Date of Birth Home Telephone Number

Home Address:

Post Code: If the child’s residence at the present address (whether living with parents or any other person) is not permanent, please state the reason and probable duration of the stay, and give the address with whom the child normally resides:

Is/has your child been subject to a care/placement order or provided with accommodation for a continuous period of more than 24 hours? Yes □ No □

If ‘yes’ which Local Authority is/was responsible? …………………………..

Please attach a copy of any court orders relating to your child. Please tick if attached. □

DETAILS OF THOSE WITH LEGAL PARENTAL RESPONSIBILITY LIVING AT THE SAME ADDRESS AS THE STUDENT.

Relationship to child ………………………… Relationship to child ………………………… Priority 1 / 2 / 3 / 4 Priority 1 / 2 / 3 / 4 Mr / Mrs / Miss / Ms Mr / Mrs / Miss / Ms

Surname…..…………………………………….. Surname…………………………………………

Forename….…………………………………….. Forename….…………………………………….

Mobile Number: Mobile Number:

Work Number. Work Number.

Email address: Email address:

NI Number: NI Number:

With your National Insurance number given above, we can check whether your child attracts extra funding for the school. Service Children in Education Indicator – are one or both parents Service personnel, serving in regular military units of any of the forces? Yes  No  I do not wish to answer this question 

OTHERS WITH PARENTAL RESPONSIBILITY AS DEFINED IN THE CHILDREN ACT 1989 Parental responsibility may be shared between a number of people beyond the child’s natural parents. Married parents have equal parental responsibility; on separation or divorce both parents continue to have responsibility. In such circumstances the school will forward copies of school reports, etc. to the separated parent if requested.

LETTERS AND REPORTS TO BE SENT TO SEPARATED PARENT  YES  NO CONTACT DETAILS

Relationship to child ………………………………. Surname…………………………………………… Priority 1 / 2 / 3 / 4 Mr / Mrs / Miss / Ms Forename………………………………………… Home Address: Home Tel Number:

……………………………………………………...... Work Number: ………………………………………………………….. Mobile Number: ……………………………..Postcode………………… Email:

From time to time it may be necessary to contact those without parental responsibility, e.g. in the case of a child’s sickness. If parents are not contactable please list below the details of any person we can contact on such an occasion. Please use an additional sheet if needed.

Relationship to child ………………………………. Surname…………………………………………… Priority 1 / 2 / 3 / 4 Mr / Mrs / Miss / Ms Forename………………………………………… Home Address: Home Tel Number:

……………………………………………………...... Work Tel Number:

……………………………..Postcode………………… Mobile Number:

PREVIOUS EDUCATION Please give below details of your child’s previous education. School Name Address Date of Date of Reason for admission leaving leaving Normal completion □ Family Move □ Voluntary transfer □ Exclusion □ Normal completion □ Family Move □ Voluntary transfer □ Exclusion □

It would be very helpful to have available the names and dates of birth of any younger siblings likely to join this school at a later date.

Name Date of Birth Name Date of Birth

DIETARY NEEDS □ No nuts of any type □ No dairy produce □ Artificial colour allergy □ Seafood allergy □ Gluten free □ Kosher food only □ Halal meat □ No pork □ Vegetarian □ Other

□ Entitled to free school meal – □ Brings own □ Paid school meal please request application form lunch/sandwiches from our school reception.

TRANSPORT

□ Taxi □ Bicycle □ Car / Van □ Car share □ Dedicated school coach / bus □ Train □ Walks □ Public Service Bus □ Bus – type not known. □ Metro / Tram / Light Rail □ London underground. □ Other

ETHNICITY

White Black or Black British Other  British  Caribbean  Chinese  Irish  African  Any other ethnic group.  Traveller of Irish Heritage  Any other Black background  Gypsy/Roma  I do not wish an ethnic  Any other white background Mixed background category to be  White and Black Caribbean recorded. Asian or Asian British  White and Black African  Indian  White and Asian  Pakistani  Any other mixed Background  Bangladeshi  Any other Asian background

HOME LANGUAGE

 Arabic  Bengali  Cantonese  Dutch  English  French  German  Greek  Gudjurathi  Hindi  Italian  Japanese  Mandarin  Polish  Portugese  Punjabi  Pushtu  Spanish  Swahili  Tamil  Thai  Turkish  Urdu  Vietnamese  Other

FIRST LANGUAGE – The language to which your child was first exposed in their early childhood and which they continue to use or be exposed to at home or in your community.

 Arabic  Bengali  Cantonese  Dutch  English  French  German  Greek  Gudjurathi  Hindi  Italian  Japanese  Mandarin  Polish  Portugese  Punjabi  Pushtu  Spanish  Swahili  Tamil  Thai  Turkish  Urdu  Vietnamese  Other

RELIGION

 Buddhist  Christian  Hindu  Jewish  Muslim  Sikh  No religion  Other MEDICAL INFORMATION

Student Name…………………………………………………………………………………………………

Name of Doctor’s Surgery:

Address of Surgery: Telephone number of Surgery:

Medical information – including allergies, asthma, serious illnesses in the past, medication requirements. Please use additional sheets if you need to.

Disability – please give details:

CONSENT TO LOCAL OFF SITE VISITS AND MEDICAL TREATMENT

I understand that my child may leave the school premises for local visits as outlined in the school prospectus and hereby give my consent for my child to participate in such visits. I also understand that my child may leave the school premises at other times when I will be informed separately by letter and when further consent will be required from me.

I agree to my son/daughter receiving medication as instructed and any urgent dental, medical or surgical treatment, including anaesthetic or blood transfusion, as considered necessary by the medical authorities present. I understand the extent and limitations of the insurance cover provided.

I have provided contact details and given necessary medical information in the admission booklet and I undertake to inform the school/party leader as soon as possible of any change in these details and in the medical circumstances of my child.

This form should be completed when a child is first admitted to school. It will be placed on the child’s school record and will be used throughout the compulsory schooling of the pupil. If a request is subsequently made for the withdrawal of the form a note or letter to that effect will be placed on the file and the copy of the form will be crossed through stating that the form has been withdrawn and the date on which such withdrawal takes effect.

PARENT / CARER NAME ……………………………………………………………………………..

PARENT / CARER SIGNATURE………………………………………………………………………