admission-form-for-sherborne-primary-school

SHERBORNE PRIMARY SCHOOL Harbour Way, Sherborne, Dorset, DT9 4AJ Telephone: 01935 812619 e-mail: office@shebornepri.dorset.sch.uk Website: www.sherbornepri.dorset.sch.uk -------------------------------------------------------------------Headteacher: Mr Ian Bartle BA Ed (Hons) NPQH

ADMISSION FORM Sherborne Area Schools’ Trust (SAST) is a Data Controller and Processor for the purposes of the General Data Protection Regulation 2016 and the Data Protection Act 2018. This legislation regulates how we obtain, use and retain information about individuals. The school is required to share some data with the DfE. With regards to photographs in school: Please advise the school office if you do NOT give permission for your child to be photographed or filmed for evaluation, promotion or publicity purposes. If we do not receive a reply then we assume consent has been allowed.

Section A - Basic Pupil Details Legal Forename: …………….......................................

Legal Surname ………………………………………

Middle Name(s): ………………………………………….

Preferred Forename: …………………………………….

Preferred Surname: …………………………………

Date of Birth: ……………………………………………..

Age at Admission: …………………………………..

Previous Surname: ………………………………………

Gender: Male/Female

Brothers/Sisters (including half/step brothers and sisters) Please list in age order any siblings who are currently at this school.

Surname

Forenames

Gender Female/Male Female/Male Female/Male Female/Male

Date of Birth

/ / / /

/ / / /

Same Address YES/NO YES/NO YES/NO YES/NO

Section B - Pupil Address House Number/Name: ………………………………........................................................................................

Street: ……..….…………………………………………………………………………………………………………

Town/City: ………………………………………….......

Postcode: ……………………………………………..

Tel: Home: ………………………………………………

E-mail: …………………………………………………

Mobile: ……………………………………………..

Please give details of all persons who have parental responsibility and anyone else you wish to be contacted in an emergency. Place them in order that you wish for them to be contacted in an emergency.

Section C – Family/Home

Contact 1: Title: ………. Forename: ……………….. Surname: ……………………………………………

House Number/Name: …………………………………..

Street…………………………………………………

Town/City: …………………………………………..........

Postcode…………………………………………….

Parental Responsibility Yes/No Relationship:  Mother  Father  Step Parent  Other Relative  Other Contact  Guardian

 Foster Parent

 Grandparent

Tick one telephone number as the Main Day Time number for use in emergency

Telephone: Home: ………………………………Main 

Work: ………………………………………Main 

Mobile: ……………………………………………Main 

Other: ………………………………………Main 

E-mail: …………………………………………………

Contact 2: Title: ………. Forename: ……………….

Surname: ……………………………………………

House Number/Name: …………………………………..

Street: ….…………………………………………….

Town/City: ………………………………………….........

Postcode: …..……………………………………….

Parental Responsibility Yes/No Relationship:  Mother  Father  Step Parent  Other Relative  Other Contact  Guardian

 Foster Parent

 Grandparent

Tick one telephone number as the Main Day Time number for use in emergency

Telephone: Home: ………………………………Main.

Work: ………………………………………Main.

Mobile: ……………………………………………Main.

Other: ………………………………………Main.

E-mail: …………………………………………………

Contact 3: Title: ……….. Forename: ………………

Surname: ……………………………………………

House Number/Name: …………………………………..

Street: ……………………………………………….

Town/City: …………………………………………..........

Postcode: ……………………………………………

Parental Responsibility Yes/No Relationship:  Mother  Father  Step Parent  Other Relative  Other Contact  Guardian

 Foster Parent

 Grandparent

Tick one telephone number as the Main Day Time number for use in emergency

Telephone: Home: ………………………………Main.

Work: ………………………………………Main.

Mobile: ……………………………………………Main.

Other: ………………………………………Main.

Section D - Pupil Medical Information: Emergency Medical Consent: 

(this confirms your agreement for the school to initiate appropriate medical treatment in the event of an emergency)

Medical Practice: …………………………....................... Dietary Needs:  Artificial colouring allergy (if applicable)  Gluten Free Practice Address: ……..….………………………………  Kosher foods only  No dairy produce …………………………………………………................  No nuts of any type/quantity  No pork Telephone: ……………………………………………….  Seafood allergy  Vegetarian Doctor’s Name: ………………………………………….  Other please state…………. ……………………………….

Medical Conditions/Information: Please include details of any allergies/medical conditions e.g. asthma, and medications regularly taken. (If you require more space please give full details on a separate sheet). ………………………………………………………………………………………………………………………….. …………………………………………………………………………………………………………………………..

If none, please state NONE…………………………………………………………………………………………

Section E - Pupil Ethnic/Cultural Information: Ethnicity:  White British  Traveller  White and Black Caribbean  Any Other Mixed Background  Bangladeshi  Black – African  Any Other Ethnic Group

      

Other White British  Gypsy/Roma  White and Black African  Indian  Any Other Asian Background  Any Other Black Background  Refused

White – Irish Any Other White background White and Asian Pakistani Black Caribbean Chinese

First Language: ENGLISH or OTHER (please specify)…………………………………………………

Home Language: ENGLISH or OTHER (please specify) ………………………………………………

Religion:  Anglican  Hindu  Muslim  Roman Catholic

   

 Christian  Methodist  Other Religion

Buddhist Jewish No Religion Sikh

Section F - Pupil Additional Information: Meals:  Free Meal

 Home

Mode of Transport:  Bicycle  School Taxi

 Car  Train

 Sandwiches

 School Meal

 Public Transport  Walks

 School Bus/Coach

Service Children in Education

 Yes

 No

Child Adopted/Guardianship:

 Yes

 No

Applied to Dorset County Council for FSM Pupil Funding:  Yes

 No

Section G - Pupil School History Please ensure you give details of any previous schools including Nursery or Private education Name & Address of Previous School: ……………………………………………………………………………..

Telephone: ………………………………… Dates Attended: ……………………………………………………

Section H - Court Orders If the pupil is subject to any Court Orders please specify the Court Order terms below. This information is CONFIDENTIAL but will help the school understand the pupil’s position. Copies of any Court Orders will need to be provided…………………………………………………………………………………..

Section I - General Parental Permissions

At Sherborne Primary School during the academic year, we have various opportunities available to the children and therefore we request that we have authority in place should these opportunities arise.

1

I agree that my child can taste different foods whilst at school.

Yes/No

My child has/has no food allergies. (please delete as necessary) My child is allergic to…………………………………………………………………………………..

2

I agree that my child can take part in activities around Sherborne Town during the school day.

Yes/No

3

I agree that my child can have access to the Internet and my child agrees to follows the rules Yes/No for Responsible Internet Use.

4.

I agree that my child can be photographed or filmed for evaluation, promotion or publicity purposes within school Yes/No

Section J – Parental signature I confirm that the above information is true and accurate. I undertake to inform the school if any of the above details change. I understand that this form does not constitute an offer of admission by the school.

Signed: …………………………………………………………

Date: ……………………………………….

Signed: …………………………………………………………

Date: ……………………………………….