Admissions Form

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:  

 

Legal Forename:  
Preferred Surname:   Preferred Forename:  
Middle Name:   Gender:

Male or Female

 
Date of Birth:   Verified By: Birth Cert Passport Other
     
Home Address:

(inc postcode)

 

 

 

 

Parental Details

Parent/Guardian 1: (with parental responsibility for the child’s educational progress)
Surname:  

 

Forename:  
Title:

Miss, Mrs, Mr etc

  Relationship:

Mother/Father/

Carer etc

 
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:  

 

Forename:  
Title:

Miss, Mrs, Mr etc

  Relationship:

Mother/Father/

Carer etc

 
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:  

 

 

Country of Birth:  

 

Nationality:  

 

Religion:  

 

First language spoken at home:  

 

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:

 
Mobile Telephone:   Mobile Telephone:  
Relationship to child:   Relationship to child:  

Medical Information

Doctors Name:   Name of

GP Surgery:

 
Address of Surgery:   Surgery Telephone:  
Does your child have any medical conditions? Yes  
No  
If yes, please state  

 

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?  

 

Is the allergy Mild  
Moderate  
Severe  
Does your child take any medication for their condition/allergy regularly? Yes  
No  
What is the medication called?  

 

 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

 

 

 

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

 

 

 Special Educational Needs

Does your child have an Educational Health Care Plan?

 

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

 
Physical Co-ordination

Difficulties with washing and dressing and taking part in games and/or physical education

 
Continence

Difficulties with going to the toilet or controlling the need to go to the toilet

 
Speech

Difficulties in communicating with others or understanding what others are saying and how he/she expresses themselves orally in writing.

 
Hearing

Difficulties with hearing what people are saying in person or the TV, radio etc

 
Eyesight

Difficulties with seeing things clearly with or without glasses

 
Memory

Difficulties with recalling events/items or ability to concentrate, learn or understand

 

 

Ability to Lift

Difficulties with carrying or otherwise moving everyday objects

 
Perception

Difficulties with the risk of danger, inability to recognise danger

eg when jumping from a height, touching a hot object

 
Please use this section to tell us about any other information that may affect your child’s welfare whilst in school

 

 

 

 

 

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

 
 

 

No

 
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  

 

 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.

Child’s

Signature:

 

 

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
 

 

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:

 

Date:
Parent/Carer Signature:

 

Thank you for completing this school data form. If you need any further information please contact the School Office on 0161 792 4317.