Parkside Primary School

Contact Form 2020/2021

PARKSIDE PRIMARY SCHOOL ACADEMIC YEAR 2020/2021 Please complete as fully as possible. (Required fields are marked with an *. Please input N/A if not applicable)

Gender

Male

Female

Year & Class

Surname of pupil

Forenames

Legal surname (if different from above)

Date of birth

Full address

Postcode

Home telephone

Mobile number

Email address

Previous setting (nursery/childminder)

Name of brother/sisters in school

Brother/sister's class

Parental responsibility. Please give information of all persons who have parental responsibility.

I understand

1.Title

1. Name

1. Relationship to child

1. Parents in Service

1. Address

2. Title

2. Name

2. Relationship to child

2. Parents in Service

2. Address

Please list, in order of preference, persons who can be contacted if your child should become unwell or have an accident during the school day.

I understand

We will phone the home number first, then mobile number, then work down the list below in order given. Also indicate persons who have permission to collect your child. Please keep us updated if any changes need to be made.

I understand

1. Title and Full Name

1.Relationship to child

1. Daytime phone number

1. Permission to collect my child

Yes

2. Title and Full Name

2.Relationship to child

2. Daytime phone number

2.Permission to collect my child

Yes

3. Title and Full Name

3. Relationship to child

3. Daytime phone number

3. Permission to collect my child

Yes

4. Title and Full Name

4. Relationship to child

4. Daytime phone number

4. Permission to collect my child

Yes

5. Title and Full Name

5. Relationship to child

5. Daytime phone number

5. Permission to collect my child

Yes

Medical information: Doctor's Name

Doctor's address

Doctor's telephone number

Please note: We must be informed of any medical information including any dietary needs, allergies or ongoing medication including asthma needs to be given below. For special dietary needs we will need medical evidence.

Other information: Any other information you feel may be relevant to assist the school in ensuring that your child receives the best possible care and attention during his/her time with us.

Country of birth

Ethnic origin

Nationality

First Language

Religion

Were you entitled to 2 year old funding?

Yes

If yes please give details of nursery/childcare used

Occasionally photographs will be taken and used to promote our school on our web site and Twitter page or in local newspapers: I give permission for my child’s photograph to be used appropriately by the school:

Yes

Video footage may be taken and used to promote our school on our web site and Twitter page: I give permission for my child’s image on video/film to be used appropriately by the school:

Yes

We send fortnightly newsletters as part of our remit of providing & supporting your child’s education. In these we may include items from 3rd parties we believe will be in your child’s interest. Are you happy to receive these electronic newsletters?

Yes

Are you or have you ever been entitled to Free School Meals?

Yes

Are there any Court Orders which relate to the student, which the school should be aware of?

Yes

Has your child been adopted from care/ have a child arrangement order/ have special guardianship arrangements?

Yes

If yes, please indicate which:

Studying out of school: It is often desirable, in the course of our work, to take children off the school site at short notice to enable them to study at first hand.

I understand

Of course the Local Education Authority’s guidelines are always strictly followed in these cases, but it would be helpful if you would give permission below to allow your child to take part in such expeditions.

I give permission for my child to take part in organised activities off the school site

I do not give permission for my child to take part in organised activities off the school site:

In the event of not being able to contact me, I give permission for my child to be taken to hospital in the event of an emergency.

Yes

Data Protection Act 1998: How we use pupil information (please tick each section to indicate you have read)

I understand

We collect and hold personal information relating to our pupils and may also receive information about them from their previous school, local authority and/or the Department for Education (DFE).

I understand

We use this personal data to: • support our pupils’ learning • monitor and report on their progress • provide appropriate pastoral care; and • assess the quality of our services

I understand

This information will include their contact details, national curriculum assessment results, attendance information, any exclusion information, where they go after they leave us...

I understand

... and personal characteristics such as their ethnic group, any special educational needs they may have as well as relevant medical information.

I understand

Type name as signature

Date of signature

Relationship to child

Please tick to act as your electronic signature

I confirm this acts as my signature