For Office Use Only
NAME:
CLASS:
START DATE:
UPN NUMBER:
PREVIOUS SCHOOL:
To be completed by a member of the Headship team:
Appropriate proof of identity and home address seen by:
Name ______Role ______
Date ______

PRIVATE & CONFIDENTIAL

NEW STARTER ADMISSIONS FORM

CHILD’S DETAILS:

LEGAL FIRST NAME______CHILD’S LEGAL SURNAME______

MIDDLE NAME______PREFERRED FIRST NAME______

DATE OF BIRTH: ______/______/______GENDER (please circle) MALE / FEMALE

MAIN ADDRESS: ______POST CODE______

HOME TELEPHONE: ______PREVIOUS SCHOOL: ______

PARENTS/CARERS DETAILS:

PARENT/CARER 1

TITLE (please circle): MR / MRS / MS / MISS / OTHER: ______

FIRST NAME______SURNAME______

ADDRESS: SAME AS CHILD / DIFFERENT: ______

MOBILE NUMBER/S: ______OTHER NUMBER______

PARENT/CARER 2

TITLE (please circle): MR / MRS / MS / MISS / OTHER: ______

FIRST NAME______SURNAME______

ADDRESS: SAME AS CHILD / DIFFERENT: ______

MOBILE NUMBER/S: ______OTHER NUMBER______

OTHER CONTACT NUMBER TO CONTACT IN CASE OF EMERGENCY

NAME______PHONE NUMBER______

NAME______PHONE NUMBER______

NAME______PHONE NUMBER______

FAMILY/SIBLINGS:

DO YOU HAVE ANY OTHER CHILDREN WHO ATTEND THE SCHOOL?

YES / NO

NAME______CLASS______

NAME______CLASS______

NAME______CLASS______

NAME______CLASS______

DIETARY REQUIREMENTS:

MEAL ARRANGEMENTS (please tick the box)

SCHOOL MEAL ⃝ARE YOU ENTITLED TO FREE SCHOOLS MEALS? YES / NO

HAVE YOU APPLIED? YES / NO

PACKED LUNCH ⃝

HOME LUNCH ⃝

DOES YOUR CHILD HAVE ANY OF THE FOLLOWING DIETARY NEEDS?

⃝ ARTIFICIAL COLOURING ALLERGY

⃝ GLUTEN FREE

⃝ HALAL FOOD

⃝ KOSHER FOOD

⃝ NO DAIRY

⃝ NO NUTS

⃝ NO PORK

⃝ VEGETARIAN

⃝ EGG ALLERGY

⃝ SEA FOOD ALLERGY

⃝ ANY OTHER______

DOES YOUR CHILD HAVE ANY OF THE FOLLOWING MEDICAL CONDITIONS?

⃝ EPILEPSY

⃝ DIABETES

⃝ ASTHMA

⃝ ECZEMA

⃝ ARTHRITIS

⃝ MULTIPLE SCLEROSIS

⃝ TUBERCULOSIS

⃝ SICKLE CELL ANAMIA

⃝ ALLERGIES (Please, specify)______

⃝ ANY OTHER______

ETHNICITY:

*Please complete the Ethnicity questionnaire.

ETHNICITY QUESTIONNAIRE

PLEASE CIRCLE ONE ONLY TO INDICATE THE ETHNIC

BACKGROUNDOF THE CHILD YOU ARE REGISTERING (please circle):

WHITE:

ALBANIAN

BORNIA / HERZEGOVINIAN

BRITISH

CROATIAN

GREEK/GREEK CYPRIOT

GYPSY / ROMA

IRISH

KOSOVAN

SCOTISH

SERBIAN

TRAVELLER OR IRISH HERITAGE

TURKISH / TURKISH CYPRIOT

WELSH

WHITE EASTERN EUROPEAN

WHITE WESTERN EUROPEAN

WHITE OTHER

______

MIXED:

WHITE AND BLACK CARIBBEAN

WHITE AND CLACK AFRICAN

WHITE AND ASIAN

ANY OTHER MIXED

ASIAN / ASIAN BRITISH

INDIAN

PAKISTANI

BANGLADESHI

ANY OTHER ASIAN BACKGROUND

______

BLACK OR BLACK BRITISH

CARIBBEAN

GHANAIAN

NIGERIAN

SOMALI

ANY OTHER BLACK BACKGROUNG

______

ANY OTHER ETHNIC GROUP:

CHINESE

AFGHAN

KURDISH

LATIN/SOUTH/CENTRAL AMERICAN

VIETNAMESE

ANY OTHER GROUP

CULTURAL:

FIRST LANGUAGE: ______HOME LANGUAGE: ______

ASYLUM STATUS (if applicable): ASYLUM SEEKER / REFUGEE (please circle)

COUNTRY OF BIRTH: ______

TRAVELER STATUS (if applicable): GYPSY-ROMA (HOUSED) / GYPSY-ROMA (TRAVELLING) /

OCUPATIONAL (TRAVELLED) / TRAVELLED (OTHER)

RELIGION: (please circle):Buddhism / Sikhism / Christian / Hindu / Jewish / Muslim /

No religion / Roman Catholic / Other religion / Refused

  1. MEDICAL CONDITION:

NAME OF CONDITION: (i.e. asthma, eczema, diabetes, etc.):

______

DIAGNOSED SINCE: ______

TREATMENT REQUIRED: ______

______

ANY OTHER VITAL INFORMATION: ______

______

  1. MEDICAL CONDITION:

NAME OF CONDITION: (i.e. asthma, eczema, diabetes, etc.):

______

DIAGNOSED SINCE: ______

TREATMENT REQUIRED: ______

ANY OTHER VITAL INFORMATION: ______

______

DISABILITY:

PLEASE STATE IF YOUR CHILD HAS A DISABILITY: YES / NO

IF YES, PLEASE PROVIDE DETAILS OF THE DISABILITY:

______

SPECIAL EDUCATIONAL NEEDS:

PLEASE, STATE IF YOUR CHILD HAS ANY SPECIAL EDUCATIONAL NEEDS: YES / NO (please circle)

IF YES, PLEASE PROVIDE DETAILS: ______

ARE THERE ANY AGENCIES OR SUPPORT WORKERS WORKING WITH YOUR CHILD OR FAMILY? (I.e. social workers, health visitors, speech and language service, etc)______

______

TRANSPORT TO SCHOOL :(PLEASE CIRCLE)

WALKBUSCAR SHARECAR/VANBICYCLE

DECLARATION:

LEGAL FIRST NAME (child): ______

LEGAL SURNAME (child): ______

PLEASE ENSURE TO READ THE FOLLOWING INFORMATION AND SIGN BELOW ONCE DONE SO:

  • The information provided in this form is CORRECT and UP-TO-DATE to my knowledge.
  • The information contained in this form will be SHARED with the Local Authority and all the relevant agencies, as required.
  • As information changes, I have the responsibility to inform the school when this may occur.
  • I understand that the school is not responsible for my child before 8:50am or after 3:15pm, unless they attend Breakfast club, Teatime club or any of the after school clubs.
  • I understand that any photo or video images taken during the school day or on any trips, events or visits organised by the school can only be used for my personal use. I understand that these images CANNOT be shared in the public domain or on social media.

PLEASE, DELETE AS PPROPIATE BELOW, INDICATING CLEARLY YOUR PERMISSION:

  • I DO / DO NOT give consent for my child to be taken off school site for LOCAL WALKING VISITS of which do not involve public or private transport.
  • I DO / DO NOT give consent for my child to be photographed for school literature and record only.
  • I DO /DO NOT give consent for my child to have access to Internet, LGFL email and other ICT facilities at school, understanding that the school can check my child’s computer files and the internet sites that they visit.

PRINT NAME______RELATIONSHIP TO THE CHILD______

SIGNATURE______DATE: ______

Hillyfield Primary Academy

ParentPay Agreement

Dear Parent/carer

In an attempt to remove all cash and cheques from school we are asking all parents to only use our e-payment system to pay for dinner money, trips and all other school activities. This can be done online using a secure website called ParentPay or through local stores where you see the PayPoint logo.

ParentPay offers you the freedom to make payments whenever and wherever you like, 24 hours a day, 7 days a week - safe in the knowledge that the technology used is of the highest internet security available.

You have a secure online account, activated using a unique set of activation codes which you will receive once your child attends school. You will be prompted to change these and create your own secure Username and Password for future logins. If you have two or more children at the school, you can merge their accounts once logged in.

Making a payment is straightforward and ParentPay holds an electronic record of your payments to view at a later date; no card details are stored in any part of the system. Once you’ve activated your account you can make online payments straight away.

Those parents wishing to pay cash should contact the school office to request the option of paying in cash at your local convenience stores displaying the PayPoint logo. PayPoint payments are recorded by ParentPay in the same way as online payments and may be seen in your payment history under ‘my accounts’.

In accordance with the School agreement we request that all accounts be paid at least two weeks in advance so that you don’t fall into arrears. Please can you sign the slip below to confirm receipt of this arrangement?

Your support by using ParentPay will help the school enormously, thank you.

Yours sincerely

Head of School

Parent/Carer Signature:-…………………………………………………………..

Hillyfield Primary Academy

Home School Agreement

Commitment of the school

As a school we will:

  • Provide a safe, secure and happy atmosphere in which to develop the whole child.
  • Value and respect your child both as an individual and as a member of the school community.
  • Provide a wide range of stimulating, challenging and enjoyable learning experiences which are tailored to suit individual needs.
  • Use class work and homework to develop your child to his/her full potential.
  • Share with you information on your child’s progress through regular parent / teacher consultation meetings, an annual end of year report.
  • Address and respond to any concerns that are raised.
  • Be open and welcoming at all times and offer opportunities for you to become involved in school life.

Commitment of the family

As a parent I will:

  • Ensure that my child attends school daily and arrives on time.
  • Inform the school if my child is absent by phoning on the first day of absence or communicate the same in writing when my child returns to school.
  • Make sure that my child comes to school appropriately dressed in school colours and that all clothing is clearly labelled.
  • Encourage and support my child through homework, reading and discussions about their life at school.
  • Make sure that holidays are taken outside school term time, unless absolutely unavoidable; then only by prior arrangement with the Head teacher.
  • Attend parent/ teacher consultations and other meetings which affect my child, including health checks and other appointments.
  • For security reasons I will report to the school office on all visits.
  • Inform the school of circumstances that may affect my child including changes of phone number or address.
  • Support the school’s behaviour policy to ensure a safe and well ordered environment.
  • Support the school’s policies, procedures and educational planning.

Head of School’s signature______

Parent’s signature ______

THANK YOU FOR TAKING THE TIME TO COMPLETE THIS FORM

Please note: Any information that you provide will be solely to compile statistics on the school careers and experiences of pupils with different ethnic backgrounds, to help ensure all pupils have the opportunity to fulfil their potential. These statistics will not allow individual pupils to be identified. From time to time the information will be passed onto the Local Education Authority and the Department for Education and Skills (DfE) to contribute to local and national statistics. The information will also be passed on to the pupil’s future school, to save it having to be asked again.