PUPIL INFORMATION FORM

Please print clearly
Surname:		Legal surname:		
Forename:		Middle name:		
Preferred name:		Gender:	Male / Female	
Address:
			Date of birth:		
		Post code:		

Please give details of all persons who have parental responsibility and anyone else you wish to be contacted in an emergency.  We prefer to have a minimum of 3 contacts.  Place them in the order that you wish for them to be contacted in an emergency.
Priority	Name/Relationship	Home contact details	Work contact details	
1	Name:

Relationship:
Date of birth:
National Insurance number:
	Address: 

Tel: 
Mobile: 
Email: 	 

Tel: 
Email: 	
2	Name:

Relationship:
Date of birth:
National Insurance number:
	Address: 

Tel: 
Mobile: 
Email: 	 

Tel: 
Email: 	
3	Name:

Relationship:	Tel: 
Mobile: 
Email: 	
Tel: 
Email: 	
4	Name:

Relationship:	Tel: 
Mobile: 
Email: 	 
Tel: 
Email: 	

Please inform the school office of any changes of address, telephone number, emergency contact etc.

Please provide details of any existing court orders:	

	

Child’s previous school or playgroup:	Tel:	
Address:

	

Travel arrangements       	(please tick ONE only)           	
		Bicycle		Train		Car/Van		Walk		Taxi		Car Share		Other		

Regular Travelling Home Permission Arrangements
Please tell us which adult(s) your child regularly has permission to go home with on days when you are not collecting them.  Please include the adult’s full name and relationship to your child.  These arrangements will remain in place until you advise us of any changes.

	Full name	Relationship to child	
Monday	
		
Tuesday	
		
Wednesday	
		
Thursday	
		
Friday	

Dietary needs:

Please continue on a separate sheet if needed and attach firmly.  If your child is having hot meals in school you will also need to complete a Special Diet Form for the hot meal provider, please see our website for more details.	

Milk - Free milk is available for all children aged under five in school, funded by the UK government.  In our school, this milk is provided by Cool Milk.  If you would like your child to receive free school milk we can register your child on your behalf.  By ticking ‘yes’ below you are giving us consent to provide Cool Milk with your child’s name and date of birth as part of the registration process.  Please tick ‘No’ if you do not wish us to register your child.  
Shortly before your child turns five, you will be offered the opportunity to pay a subsidised rate for your child to continue to receive milk.  Milk is available at lunchtime for children eligible for free school meals. 

YES 	NO
	 
www.coolmilk.com/register 	

Special needs: Please provide any information you feel relevant to enable us to support your child. The Headteacher will be happy to discuss any special needs or concerns you or your child may have i.e. learning needs, medical needs.  

Please continue on a separate sheet if needed and attach firmly.	

Pupil Name ………………………………………….

Information required by DfE – under language please tick all the languages that your child has been exposed to during their early development and currently in the home or in the community, irrespective of your child's proficiency in English
Ethnicity		Language		Religion		
Any other Asian Background		Arabic		Buddhist 		
Any other Black Background		Bengali		Christian		
Any other Ethnic Group		English		Hindu		
Any other Mixed Background		Hindi		Jewish		
Any other White Background		Spanish		Muslim		
Bangladeshi	                         	French		Sikh		
Black African		German		Other religion		
Black Caribbean		Swedish		No religion		
Chinese		Other (please state)				
Gypsy Roma						
Roma						
Indian						
Pakistani						
Traveller of Irish Heritage						
White British						
White Irish						
White Asian						
White and Black African						
White and Black Caribbean						

This information will be kept confidential.  It is required, so that we can check if your child is eligible for Pupil Premium funding.  Please delete as appropriate - 
Adopted	YES	NO	If yes, please provide evidence of an adoption certificate.	
Special Guardianship Order	YES	NO	If yes, please provide evidence that your child left care under a Special Guardianship Order.	
Child Arrangement Order (Previously known as Residence Order) 	YES	NO	Please provide evidence that your child left care under a Residence Order.	
Child looked after	YES	NO	If yes, please provide name of local authority below - 	

Please advise if your child was looked after by a local authority for one day or more in the current term.  Please specify which local authority – 

Service Personnel	YES	NO	Please advise if your child lives with a parent/carer who is serving in the regular armed forces or if your child is in receipt of a pension from the Ministry of Defence. Please provide evidence for the above arrangements.	

PARENTAL CONSENTS
Consent for your child to attend school trips and other offsite activities.

The trips and activities covered by this consent include;
o	All visits which take place during term time
o	Adventure activities
o	Offsite sporting fixtures outside the school day
The School will send you information about each trip or activity before it takes place.
You can, if you wish, tell the school that you do not want your child to take part in any particular school trip or activity.

Written parental consent will not be requested from you for the majority of offsite activities offered by the school. For example, year group visits to local amenities, as such activities are part of the school’s curriculum and usually take place during the normal school day.

I/We give permission for my/our child to take part in school trips and other activities which take place off school premises.

Signature: _________________________________                              Date: ______________________

Consent for your child to watch PG graded films (School age pupils ONLY)
Children may be shown PG graded films in class, in Starfish Club or at PTA events.
I/We give permission for my/our child to watch PG graded films.

Signature: _________________________________                              Date: ______________________

 PARENTAL CONSENTS CONTINUED
Consent for your child to use the internet
All areas of the school have access to the internet, including email.  The school internet service provider operates a filtering system which restricts access to inappropriate materials and while the school ensures suitable safeguards are in place to protect them, pupils themselves must also play their part.  We have a list of Rules for Responsible Internet Use (available on the school website), which we ask pupils to agree to and abide by.  The rules are on display in each class and are discussed with pupils.  Anyone deliberately breaking the rules will have their access to the internet within school either denied or, at the very least, severely restricted.	

I/We give permission for my/our child to access the internet.

Signature: _________________________________                              Date: _____________________	

Consent for photographs, videos and audio recordings of your child
For educational, safeguarding and organisational purposes we sometimes take photographs, videos and audio recordings of pupils.  Generally, these will be taken by school staff or by other pupils but occasionally these may be taken by other organisations e.g. local media photographers.  We really value using photos, videos and audio recordings of pupils to enrich our teaching and learning, to help us ensure children are safe and well cared for, to share school life with parents and others and to celebrate success.  

Under the General Data Protection Regulation (GDPR) schools are permitted to use photos, videos and audio recordings of pupils where it is for the fulfilment of a public task to support teaching and learning and to ensure children are safe and well cared for e.g.
•	on display boards or via whiteboards in classrooms and around school; and
•	for a number of different systems for paper and electronic management of pupil records. 

Where photos, videos and audio recordings of pupils are taken and used for reasons other than the fulfilment of a public task it is necessary to obtain parental consent. 

We would be grateful if you could please sign below to provide your consent and indicate whether your child should be named and/or unnamed for the following:
I/We give permission for 
•	photographs (including individual, group, class or whole school photos), videos and audio recordings of my/our child to be taken and used in school documents such as our newsletter and on YouTube or similar platforms with restricted access for school use and to share with parents, such as Show Cases; AND for group, class or whole school photos which include my/our child to be made available for purchase to me/us and other parents and staff which are:

	
unnamed only	

named or unnamed	
Please tick as appropriate	

I/We give permission for 
•	my/our child to take part in videos and recordings for use on YouTube or similar platforms with unrestricted access, such as Awesome Assemblies

	
Yes	

	
No	
Please tick as appropriate	

I/We give permission for 
•	my/our child to appear in photographs, videos and audio recordings that will be published online, unnamed,  for marketing purposes e.g. to appear in our school prospectus or videos showing prospective parents our school in action

	
Yes	

	
No	
Please tick as appropriate	

Where a photo, video or audio recording of your child is to be used for a specific purpose outside of the reasons listed above we will make you aware and seek your consent.  

Photographs, videos and audio recordings taken at public events/performances by parents and other third parties are considered to be for personal use and therefore, are not covered by the GDPR.  However, it is not acceptable for these to be shared publically e.g. via social media, local media, websites etc.  

If you have any questions or particular concerns and requirements please do get in touch.  

If you change your mind at any time, please contact the school and we will arrange to update your preferences.

Signature: _________________________________                              Date: ______________________

Pupil Name ………………………………………….
MEDICAL
School age pupils ONLY - Year Reception to Year 6 – NOT Little Fishes Nursery Pupils.
The school will not administer medication unless this form is completed and signed. This information will be kept securely with your child’s other records. If further information is needed we will contact you. Please do not hesitate to contact the school if there are any issues you wish to discuss.

The Medicines Policy permits the school to administer the following non-prescription medication if your child develops the relevant symptoms during the school day. Pupils will be given a standard dose suitable to their age and weight. You will be informed when the school has administered medication by text. The school holds a small stock 
of the following medicines:

Paracetamol 

Anti-histamine

Tick the non-prescription medications above that you give your consent for the school to administer during the school day and confirm that you have administered these medications in the past without adverse effect. Please keep the school informed of any changes to this consent.

Signature: _________________________________                              Date: ______________________

Print Name:  ___________________________________________________________________________

I/We give consent for any first aid or emergency medical treatment necessary to be given during the course of educational visits or activities.

Signature: _________________________________                              Date: ______________________

Print Name:  ___________________________________________________________________________

Medical Practice:			
Address:

		Tel No:	

Has your child had any of the following -	
Asthma (parents of pupils with asthma must also sign an asthma protocol form – available from the school)	YES	NO	
Bronchitis	YES	NO	
Heart condition	YES	NO	
Fits, fainting or blackouts	YES	NO	
Epilepsy	YES	NO	
Severe headaches	YES	NO	
Diabetes	YES	NO	
Allergies to any known drugs or medication	YES	NO	
Any other allergies e.g. material, food, insect bites etc. (parents of pupils prescribed an auto injector must also sign the relevant auto injector protocol form available from the school)	YES	NO	
Other illness or disability	YES	NO	
Any recent contact with contagious diseases and infections	YES	NO	
Is your child taking medication	YES	NO	
Is your child’s vaccination against Tetanus up to date	YES	NO	
Is your child receiving medical treatment of any kind from either your family Doctor or Hospital	YES	NO	
Has your child been given specific medical advice to follow in emergencies	YES	NO	

If the answer to any of the previous questions is YES please give details below including medication needed in school and dosage of any medication.

Please continue on a separate sheet if needed and attach firmly.	

For Nursery and Reception Pupils ONLY	

Tapestry Journal will allow us to share what your child is doing in school. You will also be able to send us pictures and comments about what your child is doing at home.  

Once you have given permission and agreed to the information below you will receive a Tapestry activation email to get you started. 

We require your agreement for the following – 

I give permission for -
•	my email to be shared with Tapestry
•	for my child's image and initials to appear in photographic and video media in other children's learning journals

I agree that I will not share any media contained within my child's learning journal on social media sites

Signature: _________________________________                              Date: ______________________