Newport School Admission Form

Walthamstow Reference:

Record from Birth Certificate/Passport

Child’s legal surname:

Child’s legal forename:

Child preferred forename:

Pronunciation:


Date of birth:

Child’s home address:

Gender:

Postcode:

Religion:

Ethnicity:

Nationality:

Country of Birth:

Home telephone Number:


Previous School (Name, Address, Date left):

Reason for transfer (if transferring school within borough):

School abroad:

yesno

Name and type of school:

Location:

Length of time attending:

Reason for any extended absences from school:


Mother/Carer
Record information from Birth Certificate

Name:

address:

Telephone Number:

Email Address:

Occupation:

Country of Origin:

Language Spoken:

Father/Carer

Name:

address:

Telephone Number:

Email Address:

Occupation:

Country of Origin:

Language Spoken:


Who lives with the child:

Parental Responsibility held by:

MotherFather (must be named on Birth Certificate)Other (please name)

Other:


Home Language used:

Can the child:

Understand

Speak

Read

Write

Understanding of English

Can the child:

Understand

Speak

Read

Write


Doctor's Name:

Doctors Telephone No:

Surgery Address:

Please indicate below if you are:

UK CitizenAsylum SeekerRefugee

Date of arrival in UK:

Country arrived from:

Interpreter required for teacher and parent/carer to communicate:

yesno

Which Language:


Emergency Contacts:
(Must be different to parent/carer details)

Name:

Relationship:

Address:

Telephone No:

Name:

Relationship:

Address:

Telephone No:


Child minder name:

Address:

Telephone:

Registered Childminder:

yesno


Child Position in family:

Siblings Names/Date of Birth/School:


Medical Conditions/allergies/physical impairments:
(please give details below)

Does your child take regular medication?

yesno

Details

Does your child have any special educational needs?
(please give details below)

Are any professionals/agencies involved? e.g. Hospital Consultants, Social Services. Are any court orders in place?

Family Issues (e.g. separation, disruption, domestic violence, traumatic experiences)


Diet:

No special dietary needs

Vegetarian (no fish)

Pescatarian (eats fish but no meat)

Halal meat only

No pork

Kosher food only

Do you receive any of following?

Income Support

Income-based Jobseeker’s Allowance

Child Tax Credit and your yearly income is no more than £15,575 and you do not get Working Tax Credit

Support under part VI of the Immigration and Asylum Act 1999

The guaranteed part of Pension Credit


Playing & Learning at home
Child’s favourite activities/interests? (Please give details)

How do you travel to school ?
(Car/bus/walk/bicycle etc)


Does your child attend another school/class in the community
(e.g.Mosque, private tuition, Brownies, language school)(e.g.Mosque, private tuition, Brownies, language school)?

yesno

When do they attend?

What is the name of the organization?

Who is the contact person for the group?


Is there any other information you would like to share?


Declaration

This school is registered under the Data Protection Act 1998 for holding personal data and has a duty to protect this information and to keep it up to date. The school is required to share some of the data with the Local Authority and with the DfE.

By checking this box you are digitally signing declaration