Child’s legal surname:
Child’s legal forename:
Child preferred forename:
Date of birth:
Child’s home address:
Country of Birth:
Home telephone Number:
Previous School (Name, Address, Date left):
Reason for transfer (if transferring school within borough):
Name and type of school:
Length of time attending:
Reason for any extended absences from school:
Country of Origin:
Who lives with the child:
Parental Responsibility held by:
MotherFather (must be named on Birth Certificate)Other (please name)
Home Language used:
Can the child:
Understanding of English
Doctors Telephone No:
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:
Emergency Contacts:(Must be different to parent/carer details)
Child minder name:
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?
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)
No special dietary needs
Vegetarian (no fish)
Pescatarian (eats fish but no meat)
Halal meat only
Kosher food only
Do you receive any of following?
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)?
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?
DeclarationThis 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
We believe that all pupils deserve high quality
education which engages, inspires and challenges
so that everyone meets their full potential