Student Data Collection

Student Data Collection
Name *

First Name Last Name
Middle Name Chosen Forename
Date of Birth *

Day Month Year
Date
Age *
Gender *

Female Male
Address

Street Address

Street Address Line 2

City/Town County

Post Code
Parent/Guardian and Emergency Contact Information

(Please give details of all persons with parental responsibility andanyone else you wish to be contacted in an emergency in the order you wish themto be contacted. ‘Priority 1’ will receive text alerts from school e.g. in theevent of bad weather.)
PRIORITY 1 *

First name Surname
Relationship to the child *
Address

Street Address

Street Address Line 2

City/Town County

Post Code
Interpreter required? *

Yes No
Home telephone

Area Code Phone Number
Mobile

Area Code Phone Number
Work Telephone

Area Code Phone Number
Email *
example@example.com
PRIORITY 2

Name Relationship to child
Relationship to the child
Address

Street Address

Street Address Line 2

City/Town County

Post Code
Interpreter required?

Yes No
Home telephone

Area Code Phone Number
Mobile

Area Code Phone Number
Work Telephone

Area Code Phone Number
Email
example@example.com
PRIORITY 3

Name Relationship to child
Relationship to the child
Address

Street Address

Street Address Line 2

City/Town County

Post Code
Interpreter required?

Yes No
Home telephone

Area Code Phone Number
Mobile

Area Code Phone Number
Work Telephone

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

Home Language First Language
Country of birth *
Nationality *
Other Nationality
Please tick if either parent is currently serving in the Armed Forces

Yes
Meal Arrangements (please select) *

Free School Meal (subject to eligibility) Paid school meal Packed Lunch Other (please specify below in dietary needs)
DIETARY NEEDS (E.g. any allergies)
Travel Arrangment (please select) *

LA Provided Transport Car Walk Public Transport
Has your child ever attended another Primary or Nursery School? (If so please name below:)
AGENCIES

Please provide details (e.g. names) of any agencies currently involved with your child:
Social Worker
Respite provision
Shared Care
Occupational Therapist
Consultant Pasediatrician
Any other Consultant/Specialist
Speech Therapist
Physiotherapist
Educational Psychologist
Dietician
Community Nurse
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:
Attendance mode

Part time Full time
Year Group
Registration Group
UPN
Should be Empty:

Student Data Collection

Parent/Guardian and Emergency Contact Information

Pupil Additional Information

AGENCIES

School office use: