Online Pupil Data Collection Form

  • Online Pupil Data Collection Form

  • Before completing this form, please ensure you have read the letters and information for new starters on our website:

    www.merryhill.org.uk/our-school/starting school at merry hill

    In addition to completing this admission form we will also require a copy of the birth certificate and proof of address to be submitted at a later date.

  • Has your child been allocated a Nursery, Reception or In Year school place?*

  • Child's Details

  • Child's Date of Birth*
     - -
  • Child's Gender*
  • Children Looked After*
  • SEN*
  • Social or Medical*
  • Forces Family*

  • Previous School/Setting

  • Date from:*
     - -
  • Date to:*
     - -

  • Emergency Contacts

  • Please give details of all persons who have parental responsibility and anyone else you wish to be contacted in an emergency. Due to safeguarding regulations, we must have at least 2 emergency contacts. Please list in the order that you wish them to be contacted. These nominated people would need to be available at short notice in the event of an emergency.

  • Priority 1 Contact

  • Relationship to child*

  • Parental Responsibility?*
  • Date of Birth*
     - -
  • Able to collect child?*

  • Priority 2 Contact

  • Relationship to child*

  • Parental Responsibility?*
  • Parent's Date of Birth*
     - -
  • Able to collect child?*
  • Add a 3rd contact?*

  • Priority 3 Contact

  • Relationship to child*

  • Add a 4th contact?*

  • Priority 4 Contact

  • Relationship to child*

  • Do any other individuals have legal contact arrangements with the child?*

  • Mode of Travel

    Tick the appropriate choice. Where a pupil uses more than one mode of travel for each journey in school, the longest element of the journey by distance should be recorded.
  • Mode of Travel*

  • Meal arrangements

  • If you would like your child to have a school meal and they have an allergy or a special dietary requirement you must register this with our Catering Provider - Herts Catering. Please visit https://hcl.co.uk/allergy-overview before ordering school meals. 

  • Please select your meal arrangements*

  • Medical Information

  • Does your child have any medical conditions or allergies that we should be aware of?*
  • Does your child have any special dietary requirements, due to religious beliefs or allergies?*

  • Other services involved with the child or family?

  • Family Nurse*
  • Date involvement commenced*
     - -
  • Social Worker*
  • Date involvement commenced*
     - -
  • Speech and Language*
  • Date involvement commenced*
     - -
  • CAHMS*
  • Date involvement commenced*
     - -
  • Any other service*
  • Date involvement commenced*
     - -

  • Immunisations

    Please select if your child has been vaccinated against the following:
  • Vaccinations:*
  • Has your child had any infectious diseases?*

  • Consents

  • Emergency Treatment

    I hereby give consent for the staff of Merry Hill Infant School and Nursery to:
  • Administer emergency first aid*
  • Seek emergency medical and dental attention including hospital treatment if it is deemed necessary*
  • To apply a plaster when necessary*

  • Outings

    I hereby give consent for the staff of Merry Hill Infant School and Nursery to:
  • Take my child on local visits and outings*
  • Travel on a coach or bus*
  • Travel on public transport*

  • Photographs/Videos

    I hereby give consent for the staff of Merry Hill Infant School and Nursery to
  • Photograph my child and for those photographs to be used in my child’s file and displays around the school*
  • Use photographs of my child taken at Merry Hill Infant School and Nursery in another child’s file or diary (as a group)*
  • Use photographs of my child in newsletters or on the school website*
  • Use photographs of my child for advertising purposes*

  • Sharing Information

    I hereby give consent for the staff of Merry Hill Infant School and Nursery to
  • Share information about my child with other agencies such as: Speech and Language, Health Visitors, Special educational need support*

  • Please note staff will share information without consent if they are concerned about the welfare of the child.

  • First Language

  • A first language other than English should be recorded where a child was exposed to the language during early development and continues to be exposed to this language in the home or in the community.

    If a child was exposed to more than one language (which may include English) during early development the language other than English should be recorded, irrespective of the child's proficiency in English.

    In the case of an older pupil who is no longer exposed to the first language in the home, and who now uses only another language, the pupil or parent can determine which language should be recorded.

  • First Language*

  • Ethnic Background

    Please study the list below and tick one box only to indicate the ethnic background of the pupil or child named above.
  • Ethnic group*
  • White*
  • Mixed*
  • Asian or Asian British*
  • Black or Black British*

  • Religion

  • Child's Religion*

  • Declarations

  • The information I have given on this form is complete and accurate. I understand that my personal information will be held securely and will be used only for local authority purposes.

    Please Note

    How the information on this form will be used:

    Any personal data collected will be treated as confidential under the principles of the Data Protection Act 1998. We will not use the data for any other purpose, nor will we share your data with any third parties other than the Department for Education (for statutory reporting), Hertfordshire County Council departments who may from time to time send you advice, guidance and information relating to changes to early years provision and educational services that are relevant and/or of benefit to your child, and your local children’s centre who support the local authority by assisting families to access the services that children are entitled to.

    Children who have been adopted from care or are subject to a special guardianship order or a child arrangements order.

    Eligibility will be based on your declaration that your child was formally a looked after child and on the evidence of their status e.g. a copy of the relevant order. This form and a copy of the relevant order should be seen by the school and they will confirm with Hertfordshire County Council that they have seen confirmation and enable a place to be offered under this criteria.

  • Should be Empty: