Charlton Kings Junior School

CHARLTON KINGS JUNIOR SCHOOL - ADMISSION DETAILS

Possible date of child starting at Charlton Kings Junior School ______

Child’s surname ______Date of birth ______Gender (M/F) ______

First & other names ______

Home address: ______

______Post Code: ______

Brother/sister in school (Y/N) ______Name ______

Mode of travel:

Cycle □ Car/van □ Walk □ Taxi □ Car Share □ Public Bus □ Other □

Parent/guardian/contact information

Please give details of all who have parental responsibility whether or not you wish them to be contacted and anyone else you wish to be contacted in an emergency. Place them in the order you wish them to be contacted. If necessary please continue on a separate sheet.

Contact 1 information

Surname ______Forename ______Mr/Mrs/Miss/Ms _____

Home telephone no. ______Work No: ______Mobile ______

Home address ______

______Does the child live at this address? (Y/N) _____

Relationship to child ______(e.g. parent, neighbour) Is this the child’s parent/guardian? (Y/N)___

Do you have parental responsibility? (Y/N) ______Email ______

Contact 2 information

Surname ______Forename ______Mr/Mrs/Miss/Ms _____

Home telephone no. ______Work No: ______Mobile ______

Home address ______

______Does the child live at this address? (Y/N)______

Relationship to child ______(e.g. parent, neighbour) Is this the child’s parent/guardian? (Y/N)__

Do you have parental responsibility? (Y/N) ______Email ______

Contact 3 information

Surname ______Forename ______Mr/Mrs/Miss/Ms _____

Home telephone no. ______Work No: ______Mobile ______

Home address ______

______Does the child live at this address? (Y/N)____

Relationship to child ______(e.g. parent, neighbour) Is this the child’s parent/guardian? (Y/N)__

Do you have parental responsibility? (Y/N) ______Email ______

Please turn over

Previous school, address and telephone number ______

______

Doctor’s surgery ______Doctor’s Name ______

Doctor’s telephone number ______

Any special problems your child may have (medical or other) ______

______

Regular medication ______

Language spoken at home: ______
Second Language: ______/ Others: ______
Are you likely to need translation/interpreting services? YES □ NO □
Has your child had any interaction with any of the following services? (please cross):
CAMHS (Children and Adolescent Mental Service) YES NO
Educational Psychology YES NO
SEN (Special Educational Need) YES NO
Social Care YES NO
Others (please specify)

If you have answered ‘yes’ to any of these questions please make an appointment to provide further details.

LOCAL EDUCATIONAL VISITS

During the course of your child’s studies in the Junior School, there will be occasions when groups of children may carry out local educational visits on foot, for example, to the Church or local shops.

Whenever we take your child off the school premises, we need your written consent. To save us asking your permission every time a local trip is planned, it would be helpful if you could sign the slip below to cover all visits of this nature whilst your child is in this school.

Parents will be advised on the days of planned visits and an information slip sent out whenever possible. Trained adults and adult helpers will, of course, adequately supervise all visits out of school. If you do not wish your child to go once you are informed of the visit, please let his/her class teacher know immediately in writing.

This letter only refers to those visits carried out by foot, not by car, coach or other transport. Separate permission will be sought for any trips further afield.

EDUCATION VISIT PERMISSION

I agree to my child being taken on local educational visits during their time at Charlton Kings Junior School.

Signed ______(parent/guardian)

DECLARATION

I confirm that the information given above is correct and agree to notify the school of any changes.

Signed ______(parent/guardian) Date ______