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.