Thank you for choosing Brentnall Community Primary School for your child.
Before your child can start at our school, we need you to complete an Admission Form; a paper copy will be given to you from the School Office.
The form has been copied below, you can translate this into your home language, to do so, please use the select language option located at the very bottom of our website.
Admission Form
We need this information before your child can start at Brentnall
It is imperative for safeguarding reasons that we hold this information
For office use only:
UPN No: | Start Date: | ||
Year: | DOB Proof: | ||
Class: | CTF: | ||
FSM: | SIMS info: | ||
Milk: | Home Visit: |
Pupil Details
Legal Surname: |
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Legal Forename: | |||
Preferred Surname: | Preferred Forename: | ||||
Middle Name: | Gender:
Male or Female |
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Date of Birth: | Verified By: | Birth Cert | Passport | Other | |
Home Address:
(inc postcode) |
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Parental Details
Parent/Guardian 1: (with parental responsibility for the child’s educational progress) | ||||||||||||||||||||||
Surname: |
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Forename: | ||||||||||||||||||||
Title:
Miss, Mrs, Mr etc |
Relationship:
Mother/Father/ Carer etc |
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Home Telephone: | Mobile Telephone: | |||||||||||||||||||||
Work
Telephone: |
Email Address: | |||||||||||||||||||||
Home Address:
(inc postcode) |
If different to pupil’s | |||||||||||||||||||||
Place of Work: | ||||||||||||||||||||||
National Insurance Number: | National Asylum Support Service (NASS) Number: | / | / | |||||||||||||||||||
Parent/Guardian 2: (with parental responsibility for the child’s educational progress) | ||||||||||||||||||||||
Surname: |
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Forename: | ||||||||||||||||||||
Title:
Miss, Mrs, Mr etc |
Relationship:
Mother/Father/ Carer etc |
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Home Telephone: | Mobile Telephone: | |||||||||||||||||||||
Work
Telephone: |
Email Address: | |||||||||||||||||||||
Home Address:
(inc postcode) |
If different to pupil’s | |||||||||||||||||||||
Place of Work: | ||||||||||||||||||||||
National Insurance Number: | National Asylum Support Service (NASS) Number: | / | / | |||||||||||||||||||
Additional Information
Please state any siblings that are already attending Brentnall Primary: |
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Country of Birth: |
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Nationality: |
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Religion: |
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First language spoken at home: |
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Is English an additional language? | Yes | ||
No | |||
Has your child ever been in the care of the Local Authority? | Yes | ||
No | |||
Are any parents/carers in the Armed Forces? | Yes | ||
No | |||
Ethnicity: Please tick which best describes your child’s ethnicity | |||||
White-British | White & Black Caribbean | Black Caribbean | |||
White-Irish | White & Black African | Black African | |||
Other White background | Other mixed backgroung | Other Black background | |||
Chinese | Indian | Other Asian background | |||
Pakistani | White and Asian | Other ethnic group | |||
Traveller of Irish heritage | Gypsy/Roma | Refused |
Education History
Name of previous school | |
Date of leaving | |
Reason for leaving | |
If no previous school
Date of arrival in the UK |
Emergency Contact Details (other than parents)
Emergency Contact 1 | Emergency Contact 2 | ||
Name: | Name: | ||
Home
Telephone: |
Home
Telephone: |
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Mobile Telephone: | Mobile Telephone: | ||
Relationship to child: | Relationship to child: |
Medical Information
Doctors Name: | Name of
GP Surgery: |
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Address of Surgery: | Surgery Telephone: | |||
Does your child have any medical conditions? | Yes | |||
No | ||||
If yes, please state |
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Does your child have asthma?
If yes, please ensure that your child has their inhaler in school at all times. |
Yes | |||
No | ||||
Does your child wear glasses?
If yes, please ensure that your child has their glasses in school. |
Yes | |||
No | ||||
Has your child had a tetanus injection in the last 5 years? | Yes | |||
No | ||||
Is your child sensitive to penicillin? | Yes | |||
No | ||||
Does your child have any allergies? |
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Is the allergy | Mild | |||
Moderate | ||||
Severe | ||||
Does your child take any medication for their condition/allergy regularly? | Yes | |||
No | ||||
What is the medication called? |
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Medical Consent
I provide consent for: | ||||
School to use sterile wipes on cuts and grazes | Yes | No | ||
School to use plasters on cuts and grazes | Yes | No | ||
My child to receive emergency first aid, medical or surgical treatment as considered necessary by the medical authorities present (including anaesthetic and blood transfusion). We will always contact you in such an event | Yes | No | ||
The information in the school’s statistical return to the DFE to be shared with Public Health Services (School Nurse) for immunisation programme purposes? | Yes | No |
Keeping us Informed
I understand that: | ||||
I must update school should there be any change to the allergy/dietary/medical information provided | Yes | No | ||
Only prescribed medicines may be administered to my child & that a separate signed form must be completed | Yes | No |
Additional Needs
Do you consider your child to have a disability?
If yes, please select from the option(s) below |
Yes | ||||
No | |||||
Learning Disability | Hearing Impairment | Visual Impairment | |||
Physical Disability | Other Please Specify
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Do you consider yourself to have a disability?
If yes, please select from the option(s) below |
Yes | ||||
No | |||||
Learning Disability | Hearing Impairment | Visual Impairment | |||
Physical Disability | Other Please Specify
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Special Educational Needs
Does your child have an Educational Health Care Plan?
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Yes | |
No | ||
Does your child have any special educational needs?
If yes, please select from the option(s) below |
Yes | |
No | ||
Mobility
Difficulties with manual dexterity, holding a pen, throwing and catching a ball |
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Physical Co-ordination
Difficulties with washing and dressing and taking part in games and/or physical education |
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Continence
Difficulties with going to the toilet or controlling the need to go to the toilet |
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Speech
Difficulties in communicating with others or understanding what others are saying and how he/she expresses themselves orally in writing. |
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Hearing
Difficulties with hearing what people are saying in person or the TV, radio etc |
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Eyesight
Difficulties with seeing things clearly with or without glasses |
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Memory
Difficulties with recalling events/items or ability to concentrate, learn or understand |
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Ability to Lift
Difficulties with carrying or otherwise moving everyday objects |
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Perception
Difficulties with the risk of danger, inability to recognise danger eg when jumping from a height, touching a hot object |
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Please use this section to tell us about any other information that may affect your child’s welfare whilst in school
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Income Support
Is your joint family income over £16,190 per year? | Yes | |
No | ||
Is your family in receipt of any benefits listed below?
· Income Support · Income-based Job Seekers Allowance · Income related Employment and Support Allowance · Support for NASS (National Asylum Support Service · The guarantee element of State Pension Credit · Child Tax Credit (with no working Tax Credit) · Working Tax Credit run-on · Universal Credit |
Yes |
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No |
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You may be able to claim Free School Meals, you can do this by checking the criteria on the government website https://www.gov.uk/apply-free-school-meals or by calling Salford City Council on 0161 793 2500. |
Meal Arrangements
Free School Meal | Paid School Dinner | Packed Lunch | |||
Does your child have any dietary needs? | Yes | ||||
No | |||||
If yes, please state dietary need, including any linked to religious beliefs |
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Transport
Which mode of transport do you take to travel to school? | |||||||
Walk | Bus | Car | Cycle |
Educational Visits
I provide consent for my child to: | ||||
Take part in occasional supervised visits to places of interest: some examples listed below
· Local parks – Broughton, Heaton etc · Walks around the local area · Library · Local shops · School trips · Local sporting venues · Museums · Local schools · Learning centres |
Yes | No | ||
Take part in food tasting activities in school | Yes | No |
Swimming Ability
Is your child able to swim 50 metres? | Yes | No | ||
Is your child water confident in regard to the proposed activity? | Yes | No | ||
I confirm that my child is in good health and I consider them fit to participate | Yes | No |
Parental Consent
You have the right to change or withdraw your consent preferences at any time by contacting the School Office.
I provide consent to: | ||||
School contacting me by text with reminders & updates | Yes | No | ||
School contacting me by email with reminders & updates | Yes | No | ||
Receiving marketing material from school including events, offers, newsletters etc | Yes | No | ||
Receiving marketing material from third-party organisations which may be a specific interest to parents e.g Salford City Council services etc | Yes | No |
Photographs and Video Use
At Brentnall Community Primary School, we sometimes take photographs and videos of pupils. We use these photographs and videos on the school’s newsletter, website, social media and on the display boards around school.
We would like your consent to take photographs and videos and to use them in the ways described above. If you are not happy for us to do this isn’t a problem – we will accommodate any preferences.
Please note you have the right to update these options at any point by contacting the School Office.
I consent to: | ||||
School using the name of my child on their website | Yes | No | ||
School using photos/videos of my child on their website | Yes | No | ||
School using photos/videos of my child in school
e.g teacher observations, assessments, in-school displays |
Yes | No | ||
School using photos of my child in the their publications
e.g newsletter and prospectus |
Yes | No | ||
School using photos of my child involved in group work in other children’s books/learning journals | Yes | No | ||
School using photos/videos of my child on social media
e.g Twitter, Instagram, You Tube etc |
Yes | No | ||
Staff using photos/videos of my child on their own educational social media accounts | Yes | No | ||
The media using photos/videos of my child to promote Brentnall Community Primary School or an event/activity that has operated in partnership with the school
e.g local and national newspapers, Manchester Utd etc |
Yes | No | ||
The media using photos/videos of my child to promote Brentnall Community Primary School or an event/activity that has operated in partnership with the school on their social media accounts
e.g local and national newspapers, Manchester Utd etc |
Yes | No | ||
Other schools using photos/videos of my child linked to Brentnall Community Primary School
e.g sporting events, curriculum activities etc |
Yes | No | ||
Other schools using photos/videos of my child linked to Brentnall Community Primary School on their social media accounts
e.g sporting events, curriculum activities etc |
Yes | No |
Early Years
This section is only required to be filled for children in Early Years (Nursery & Reception)
I provide consent for: | ||||
Staff to assist my child with brushing their teeth | Yes | No | ||
Staff to change my child’s clothes in the event of an accident/water play | Yes | No | ||
Staff to observe and record my child’s development on Target Tracker | Yes | No | ||
Staff to apply the sun cream (that I provide) to my child’s face, arms and legs when necessary. | Yes | No |
Safety Online
*to be completed by both the parent and child*
Child: I agree to comply with Brentnall Community Primary School’s Acceptable Use Policy for the use of email and the internet. I will use the network in a responsible way and observe all the restrictions explained by the school.
Parent: As the parent or legal guardian of the child above, I grant permission for my child to use email and the internet. I understand that he/she will be held responsible if they do not observe the Acceptable Use Policy that is in place at school. |
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Child’s
Signature: |
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Date: | |
Parent/Carer’s Signature: | Date: |
Collection Consent
It is important that we make sure that children are released safely at the end of each day. We ask that you set up a password on your child’s records which can be used in the event of you not being able to collect your child.
Password |
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If you are unable to collect your child, please call the School Office before 3pm to let us know who will be collecting your child at the end of the school day; to check that they have the correct password.
A staff member will only release your child if the correct password is given by your chosen adult & will not release a child to a sibling that is under the age of 16 years old.
I confirm that the information provided within this form is correct and I agree to inform school should any information require updating. | |
Parent/Carer Name:
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Date: |
Parent/Carer Signature:
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Thank you for completing this school data form. If you need any further information please contact the School Office on 0161 792 4317.