Data Collection Form

Hackleton CEVA Primary School

Data Collection Form

The school and the Local Education Authority are required under Data Protection legislation to comply with essential good practice in respect of the information collected here and to manage it securely. The individuals who are the subject of the information or who have parental/guardian responsibility are generally entitled to see the information and are encouraged to help keep the information up to date. This information will be used for educational, welfare, planning or managerial purposes. For full details please ask the school for a copy of their Privacy Notice.


Section 1 - Pupil Details

 
Surname *
Legal Surname (if different to above)
Forename *
Preferred Forename *This is the name your child is to be known by
Middle Name
Date of birth *
Gender at birth *
Address including postcode *
Please provide the name and address of the previous school, pre-school or nursery attended *
Please provide the name of any siblings that currently attend or have previously attended this school *
Is your child eligible for free school meals?*For more information about eligibility, please visit https://www.westnorthants.gov.uk/schools-and-support/free-school-meals-and-pupil-premium please
Yes
No
Don't know
Does your child have any dietary requirements?*
Yes
No
If yes, please give details

Please provide details of medical information.

Name of doctor *
Name and address of surgery *
Telephone number of surgery *
Brief details of any medical conditions *
Please provide any details of Special Educational Needs *
Is there an Education, Health and Care Plan in place?
Yes
No
Is the child a Service Child?*Schools are required to indicate whether a child has a parent/guardian serving in regular military units of the armed forces and designated as Personnel Category 1 or 2
Yes
No
Is the child in Local Authority care?
Yes
No
If yes, please enter name of local authority
Ethnicity *
Home language *
First language *
Nationality *
Religion *

Section 2 - Parent/Guardian Contact Details

 

Please give details of all persons that have parental responsibility. Email addresses will be used to send correspondence from school.

Parent/Guardian 1

Title *
Name *
Relationship to Child *
Parental Responsibilty*
Yes
No
Mobile number *
Home Tel Number
Work Tel Number
Email address *
Address and Postcode

Parent/Guardian 2

Title *
Name *
Relationship to Child *
Parental Responsibilty*
Yes
No
Mobile number *
Home Tel Number
Work Tel Number
Email address *
Address including Postcode *
Please give details of any court orders in place

Section 3   - Emergency Contact Details

Please provide the details of at least two emergency contacts in priority order. This is in addition to the parent contact details above.

Emergency Contact (Priority 1)

Title *
Name *
Relationship to child *
Address (incl postcode) *
Mobile Number *
Home telephone number
Work telephone number

Emergency Contact (Priority 2)

Title *
Name *
Relationship to child *
Address (incl postcode) *
Mobile Number *
Work telephone number
Home telephone number

Emergency Contact (Priority 3)

Title *
Name *
Relationship to child *
Address (incl postcode) *
Mobile Number *
Work telephone number
Home telephone number
Signature of parent/guardian *Use your finger or mouse to input signature
Clear
Date *
Submit