Gloucester Primary School Entry Form

Child’s Surname / Date of Birth / ___/____/______
Child’s First Name / NHS No.
Gender
Child’s
address / Postcode
This address is in the London Borough of

Collection of Pupil NHS Numbers

The pupils’ NHS Number is being collected by schools as additional information. It may be used in the event of a medical emergency to enable the NHS to access the pupils’ records more quickly. Additionally it will be shared with the Local Authority to allow services to work more effectively in supporting children in schools.

Child’s Arrangements before / after school:

Brought to school by / Collected at 3:30 by
Telephone contact No. / Telephone contact No.
If your child makes his / her own way to and from school, please tick

Family Structure: Residential Care { } Foster Parents { } One parent /one non parent { }

Single parent { } Two Parents { }.

Number of children in your family? …………………Childs position in the family 1 2 3 4 5 6

Are there any other children from your family attending Gloucester? …………………………

…………………………………………………………………………………………………………

Previous Education:

Nursery Experience: Yes /No

Education Abroad: Yes /No

Previous School (s) ……………………………………………………………………………….

Address ……………………………………………………………………………………………...

Postcode …………………………………………Tel : …………………………………………..

Does your child enjoy school Yes/ No

Do you have any test result’s for your child (SATS)…………………………………………

Are there any SEN concerns? ......

What is the nature of the concern? …………………………………………………………..

What aspect of your school does your child particularly enjoy? Art /Music /Sportsetc

……………………………………………………………………………………………………….

How does your child spend time at home? Computers/TV/Reading / Playing with

siblings etc ………………………………………………………………………………………..

Collection of National Insurance/National Insurance/ National Asylum Support Service (NASS) NumberInformation

The collection and assessmentof National Insurance/National Insurance/National Asylum Support Service (NASS) Number information by the Local Authority ensures that schools and pupils are funded to their appropriate level and ensures that the statutory data shared with the Department for Education at School Census accurately reflects the situation in the school.

Schools now receive additional funding, the Pupil Premium, for each pupil on their roll assessed and registered as eligible. This is £600 per pupil for 2012-13. This is assessed using the National Insurance/ National Asylum Support Service (NASS) Number and allows schools to maximise their available resources. An additional part of this assessment may indicate if there is additional funding available in the form of Free School Meal eligibility. All information provided will be held securely.

Current Pupil Premium/Free School Meal Legislation

Parent/guardians details

Parent/guardian 1 First Name
Parent/guardian 1 Last (family) Name
Telephone No. 1 / Mobile Phone No. 1
e-mail address
Work No.
National Insurance No. / Date of Birth / ___/____/_____
National Asylum Support Service (NASS) Number / NI/NASS Unavailable?
Address
Parent/guardian 2 First Name
Parent/guardian 2 Last (family) Name
Telephone No 2 / Mobile Phone No 2
e-mail address
Work No.
N National Insurance No. / Date of Birth / ___/____/_____
National Asylum Support Service (NASS) Number / NI/NASS Unavailable?
Address
Names and addresses of 2 other persons who have agreed
to be contacted by us in an emergency
Name / Name
Address / Address
Tel. No / Tel. No
Relationship to child: / Relationship to child:

Please be sure to inform us immediately of any changes in this information.

This is vital in the interest of the safety of your child.

Information related to your child’s learning

A child progresses most quickly when home and school are working together.

It is important, therefore, that the school knows relevant information about each child, which can assist the teacher to build on strengths and improve weaknesses.

Similarly, parents are encouraged to enquire at any time, if they wish to know about the schools aims and methods.

It is important that you get to know your child’s teacher, early in the school year.

The following information will be of great value to us:

Language Spoken at Home
If not English please comment on your child’s level of English speaking
Does your child understand any languages other than English?

Religious Requirements ______

Religion

Buddhists □ Christian □ Hindu □ Muslim □ Sikh □ No Religion □

Other□ ______

Child’s ethnic origin

Please tick or comment if ‘other’

Black British / □ / Pakistani / □
African / □ / White British / □
Caribbean
Nigerian / □
□ / Mixed Background
Other European / □
□
Arab / □ / Irish / □
SE Asia / □ / Greek / □
Bangladeshi / □ / Turkish / □
Indian / □ / Other ______

Responsibility of your child

I understand that the school is in no way responsible for my child before 8.45am or after 3.30pm.

Signed / Parent / guardian / Date

Essential Medical Information

Does your child suffer from any of the following?

Eczema / Yes / No / Asthma / Yes / No
Migraine / Yes / No / Epilepsy / Yes / No
Diabetes / Yes / No / Sight problems / Yes / No
Allergies / Yes / No / Hay Fever / Yes / No
Any other problem / disability
If the answer is YES to any of the above
What is the normal treatment?
Will medication be needed in school? / Yes / No
Who should be contacted if illness occurs?
Any other information relevant to the problem?
Does your child wear glasses in school? / Yes / No

Please give the name and address of your child’s Doctor

Name of Doctor/
Address
Telephone No.
Has the Doctor put any restrictions on physical activities e.g. games, swimming, PE? / Yes / No
If YES, please give details
Are there any restrictions on any particular food? / Yes / No
If YES, please give details
Has your child been vaccinated against Tetanus? / Yes / No
If YES, date of vaccination / Date ___/___/______
School Journey (older children) Will you be giving your child travel sickness pills? / Yes / No
If YES, which brand?

Please note: The authority recommends that medicines should be taken at home, wherever possible. If this is unavoidable, all medicine must be brought to the school office, clearly labelled with your child’s name and class together with instructions for administering it. If your child is unwell, please do not send them to school. A note should be sent to school on your child’s return, giving a detailed explanation for absence.

Permission for local visits

I give permission for my child to be taken out of school on local visits, which do not involve public or private transport.

Signed ______Date

Please print parent/carer name

Permission for photographs and filming

From time to time children may be involved in photography or filming either for school use or media presentations. We would be grateful if you could give written permission in advance. We will always endeavour to inform you the day before when the press or media are involved.

I do / do not give permission for my child to be photographed

I do / do not give permission for my child to be filmed

Signed ______Date

Please print parent/carer name

PRIVACY NOTICE TEMPLATE
for
Pupils in Schools, Alternative Provision and Pupil Referral Units
and Children in Early Years Settings
(This is suggested text which can be amended to suit
local needs and circumstances)

Privacy Notice - Data Protection Act 1998

We Gloucester Primaryare a data controller for the purposes of the Data Protection Act. We collect information from you and may receive information about you from your previous school and the Learning Records Service. We hold this personal data and use it to:

  • Support your teaching and learning;
  • Monitor and report on your progress;
  • Provide appropriate pastoral care, and
  • Assess how well your school is doing.

This information includes your contact details, national curriculum assessment results, attendance informationand personal characteristics such as your ethnic group, any special educational needs and relevant medical information. If you areenrolling for post 14 qualifications we will be provided with your unique learner number (ULN) by the Learning Records Service and may also obtain from them details of anylearning or qualifications you have undertaken.

We will not give information about you to anyone outside the school without your consent unless the law and our rules allow us to.

We are required by law to pass some information about you to the Local Authority and the Department for Education (DfE)

(For Academy use only) We are required by law to pass some information about you to the Department for Education (DfE) and, in turn, this will be available for the use(s) of theLocal Authority.

If you want to see a copy of the information about you that we hold and/or share, please contact (Insert name of School Administrator).

If you require more information about how your information is stored, then please go to the following website:

If you are unable to access this website we can send you a copy of this information. Please contact the DfE as follows:

  • Public Communications Unit
    Department for Education
    Sanctuary Buildings
    Great Smith Street
    London
    SW1P 3BT

Website:

email:
Telephone:0370 000 2288

In addition for Secondary and Middle deemed Secondary Schools

Once you are aged 13 or over, we are required by law to pass on certain information to the provider of youth support services in your area. This is the local authority support service for young people aged 13 to 19 in England. We must provide the address of you and your parents (and your date of birth) and any further information relevant to the support services' role.

However, until you are aged 16 or older, your parent(s) can ask that no information beyond yourname, address and date of birth (andtheir name and address) be passed on to the youth services provider.This right transfers to youonyour 16th birthday.Please inform (Insert name of School Administrator) ifthis is what youor your parents wish.

For more information about young peoples’ services, please go to the Directgov Young People page at the LA website shown above.