Student Data Collection

PUPIL DATA COLLECTION FORM
Name*

First NameLast Name
Middle NameChosen Forename
Photo of your child (head shot only required)-
Date of Birth*

DayMonthYear
Date
FemaleMale
Address*

Street Address

Street Address Line 2

City/TownCounty

Post Code
Parent/Guardian and Emergency Contact Information

Please provide details of all individuals with parental responsibility, as well as any additional emergency contacts, listed in your preferred order of contact. “Priority 1” will be the school’s first point of contact. A minimum of three contacts must be provided.
PRIORITY 1*

First nameSurname
Relationship to the child*
Address*

Street Address

Street Address Line 2

City/TownCounty

Post Code
YesNo
Home telephone

Area CodePhone Number
Mobile

Area CodePhone Number
Work Telephone

Area CodePhone Number
Email*
example@example.com
PRIORITY 2*

First NameSurname
Relationship to the child*
Address

Street Address

Street Address Line 2

City/TownCounty

Post Code
YesNo
Home telephone

Area CodePhone Number
Mobile

Area CodePhone Number
Work Telephone

Area CodePhone Number
Email
example@example.com
PRIORITY 3*

First NameSurname
Relationship to the child*
Address

Street Address

Street Address Line 2

City/TownCounty

Post Code
YesNo
Home telephone

Area CodePhone Number
Mobile

Area CodePhone Number
Work Telephone

Area CodePhone Number
Email
example@example.com
Pupil Additional Information
Doctor/ GP:
Medical Practice:
Ethnicity*
Religion*
Religion*
Language*

Home LanguageFirst Language
Country of birth*
Nationality*
Yes
Free School Meal (subject to eligibility)Paid school mealPacked LunchOther (please specify below in dietary needs)
DIETARY NEEDS (E.g. any allergies)
Please not that if your child is on Free School Meals at their current school, you will need to re-apply for these with Bradford Council, with the new school details.
LA Provided TransportCarWalkPublic TransportOther
Has your child ever attended another Primary or Nursery School? (If so please name below:)
PUPIL COLLECTION PERMISSIONS
We need to confirm details of who will be collecting pupils from school to ensure the safety of your children.

If you will be collecting your children from school, please provide the names of people who are authorised to collect them.

Likewise, if any orders are in place and a person is NOT AUTHORISED to collect your child, please let school know.

Please provide the names of people who ARE AUTHORISED TO COLLECT YOUR CHILDREN-

Rows	Name	Days	Relationship to child
Person 1
Person 2
Person 3

Photo of person 1
Photo of person 2

Please provide the name of anyone who IS NOT AUTHORISED TO COLLECT YOUR CHILD-

Rows	Name	Order in place?	Relationship to child
Person 1

Photo of person NOT ALLOWED TO COLLECT-
AGENCIES

Please provide details (e.g. names and numbers) of any agencies currently involved with your child:
Social Worker
Email
example@example.com
Phone Number

Area CodePhone Number
Respite provision
Email
example@example.com
Phone Number

Area CodePhone Number
Shared Care
Email
example@example.com
Phone Number

Area CodePhone Number
Occupational Therapist
Email
example@example.com
Phone Number

Area CodePhone Number
Consultant Paediatrician
Email
example@example.com
Phone Number

Area CodePhone Number
Any other Consultant/Specialist
Email
example@example.com
Phone Number

Area CodePhone Number
Speech Therapist
Email
example@example.com
Phone Number

Area CodePhone Number
Physiotherapist
Email
example@example.com
Phone Number

Area CodePhone Number
Educational Psychologist
Email
example@example.com
Phone Number

Area CodePhone Number
Dietician
Email
example@example.com
Phone Number

Area CodePhone Number
Community Nurse
Email
example@example.com
Phone Number

Area CodePhone Number
Any other persons/agencies:
- Data Protection Act 1998:The school is registered under the Data Protection Act for holding personaldata. The school has a duty to protect this information and to keep it up todate. The school is required to share some of the data with the Local Authorityand with the DfE.
- School office use:
- Part timeFull time
- Year Group
- Registration Group
- UPN
- Should be Empty:

Parent/Guardian and Emergency Contact Information

Pupil Additional Information

PUPIL COLLECTION PERMISSIONS

AGENCIES

School office use: