Cleeve Park School - In Year Admissions Application Form

Cleeve Park School - In Year Admissions Application Form

Please provide the information requested below which is for our records and remain confidential to the school. Under the Data Protection Acts we are required to advise you that many of your answers will be stored electronically.
Please Note: You can save and come back to the form before submitting in case you do not have certain information or documents to hand.

Next Steps: Once we have received your completed form a member of our admissions team will contact you to advise you of the next steps or, if we have no spaces in the requested year group, we will advise you that your child has been placed on the waiting list.

Should any of your details change, please ensure you inform us immediately.

Child's Details
Child's Legal Forename and Surname

Legal ForenameMiddle Name(s)Legal Surname
Child's Preferred Forename and Surname (if different to above)

Preferred ForenamePreferred Surname
Child's Date of Birth

DayMonthYear
Date of birth
Child's Gender
Child's Current Address

Street Address

Street Address Line 2

Town/CityCounty

Postal Code
Child's Home Phone Number

Area CodePhone Number
First Language Spoken at Home?

Educational Details
Which school does your child currently attend? (If Home Educated please put in EHE)
My Child's Current Year Group
What is your child's reason for seeking an in year admission?
Has your child ever been Permanently Excluded from Education?
Please upload a copy of your child's latest/most recent school report here:

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Additional Educational Information

Please include any information you think is relevant
SEND/EAL:
If you have indicated that your child has SEND needs please upload any supporting documents.

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Other Agencies Involvement/Adopted from Care:
Upload any documents you think may be relevant regarding the above:

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Normal Lunchtime Arrangements

Please note: Children currently receiving Free School Meals (FSM) will not automatically qualify for FSMs when moving from Primary to Secondary School. You will need to use our FSM Checking Service.
My Child's lunchtime arrangements will be:
My Child is currently eligible for Free School Meals

Medical
Doctor's Surgery Name:
Name of surgery
Surgery Telephone Number

Area CodePhone Number
Known Medical Conditions (if any):
Does your child take any prescribed medication?
Please list any prescription medication taken:
Please upload a photo of any PRESCRIBED medications (please ensure that you take a photo that includes the dispensing label with the child name on)

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Allergies (if any):
Student is Asthmatic as diagnosed by Healthcare Professional
Details of Asthma medication prescribed:
Medication type and dosage
An Adrenaline Pen is needed for Severe Allergies
Brand and prescribed dose of adrenaline pen:
Medication type and dosage
Any Additional Medical Information:

First Parent / Carers Details

Please read notes below:
Name

Title (Mr/Mrs/Ms etc.)ForenameSurname
Address

Street Address

Street Address Line 2

Town/CityCounty

Postal Code
Home Phone Number

Area CodePhone Number
Mobile Phone Number
Please enter a valid phone number.Format: 00000000000.
Work Phone Number
Format: 00000000000.
Relationship to child
Mother/Father/Carer/Guardian etc.
Email
example@example.com
Contact Priority for emergency's and communication (emails/reports etc. See note at start of section)
Court Orders / Other information
Please use this space to add any extra information about this contact the school needs to know about

Second Parent / Carers Details (if applicable)

Please read notes below:
Name

Title (Mr/Mrs/Ms etc.)ForenameSurname
Address

Street Address

Street Address Line 2

Town/CityCounty

Postal Code
Home Phone Number

Area CodePhone Number
Mobile Phone Number
Please enter a valid phone number.Format: 00000000000.
Work Phone Number
Format: 00000000000.
Email
example@example.com
Relationship to child
Mother/Father/Carer/Guardian etc.
Contact Priority for emergency's and communication (emails/reports etc.)
Court Orders / Other information
Please use this space to add any extra information about this contact the school needs to know about

First Additional Emergency Contact

Should an emergency occur at school it is sometimes necessary to contact a parent or carer during the daytime. If for any reason we are unable to make contact with parents or carers, please indicate below additional emergency contacts which may be reached during school hours. We are required to hold more than one emergency contact number for each student.
Name

Title (Mr/Mrs/Ms etc.)ForenameSurname
Home Phone Number

Area CodePhone Number
Mobile Phone Number
Please enter a valid phone number.Format: 00000000000.
Work Phone Number
Format: 00000000000.
Email
example@example.com
Relationship to child
Mother/Father/Aunt/Uncle/Friend/Carer/Guardian etc.
Contact Priority for emergency's
Other information
Please use this space to add any extra information about this contact the school needs to know about

Other Emergency Contact

Should an emergency occur at school it is sometimes necessary to contact a parent or carer during the daytime. If for any reason we are unable to make contact with parents or carers, please indicate below additional emergency contacts which may be reached during school hours. We are required to hold more than one emergency contact number for each student.
Name

Title (Mr/Mrs/Ms etc.)ForenameSurname
Home Phone Number

Area CodePhone Number
Mobile Phone Number
Please enter a valid phone number.Format: 00000000000.
Work Phone Number
Format: 00000000000.
Email
example@example.com
Relationship to child
Mother/Father/Aunt/Uncle/Friend/Carer/Guardian etc.
Contact Priority for emergency's
Other information
Please use this space to add any extra information about this contact the school needs to know about

Proof of Identity

Please upload a digital copy of the documents below. A clear photo of the document is adequate.
A copy of a proof of address (such as Bank Statement, Bill or Council Tax Statement)

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A copy of my child's original Birth Certificate or Passport

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A formal head shot photograph of my son / daughter

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Parent/Carer Declaration

I agree to co-operate in providing all items of uniform for the full length of my son's/daughter's time at Cleeve Park. I agree to co-operate with the school in ensuring my son/daughter attends school regularly and punctually, and works and behaves appropriately. I agree that by providing the school with any medical information about my son/daughter that I am consenting to the sharing of this information with all relevant staff and the recording of this in the school’s medical alert booklet.
Name

First NameLast Name
Signature
Date

DayMonthYear
Date
Relationship to Applicant:

Child's Details