Reception Admissions Form

1. Student Details

Legal First Name* Legal Middle Names Legal Last Name*

Gender*MaleFemaleOther

Date of Birth (DD/MM/YY)* Student Address Line 1* Student Address Line2 Student Address Line 3 Student City/Town* Post code* Language*

Select the following*Native LanguageSpeaks LanguageUnderstands LanguageIs Spoken at Home

Language 2

Select the followingNative LanguageSpeaks LanguageUnderstands LanguageIs Spoken at Home

Fluent in English?*YesNo

Religion* Ethnicity* Mode of Transport*

2. Family Information

parent/guardian 1 details

Parent/Guardian 1 Title* Parent/Guardian 1 First Name* Parent/Guardian 1 Last Name* Parent/Guardian 1 Relationship*

Parent/Guardian 1 Primary Guardian? (Y/N)*YesNo

Parent/Guardian 1 Legal Guardian? (Y/N)*YesNo

Parent/Guardian 1 Authorised to Collect? (Y/N)*YesNo

Parent/Guardian 1 Lives with Student? (Y/N)*YesNo

Address: If address is different from child please enter here Parent/Guardian 1 Mobile Number* Parent/Guardian 1 Home Telephone Number Parent/Guardian 1 Work Telephone Number Parent/Guardian 1 Email Address*

parent/guardian 2 details

Parent/Guardian 2 Title* Parent/Guardian 2 First Name* Parent/Guardian 2 Last Name* Parent/Guardian 2 Relationship*

Parent/Guardian 2 Primary Guardian? (Y/N)*YesNo

Parent/Guardian 2 Legal Guardian? (Y/N)*YesNo

Parent/Guardian 2 Authorised to Collect? (Y/N)*YesNo

Parent/Guardian 2 Lives with Student? (Y/N)*YesNo

Address: if different from child please enter address here Parent/Guardian 2 Mobile Number* Parent/Guardian 2 Home Telephone Number Parent/Guardian 2 Work Telephone Number Parent/Guardian 2 Email Address*

siblings

Details of Siblings at this School

	Sibling 1	Sibling 2	Sibling 3
Name
D.O.B

Siblings in other schools

	Sibling 1	Sibling 2	Sibling 3
Name
D.O.B

3. emergency information

Please fill in details below of emergency contacts if we have difficulty contacting a primary guardian, we will contact the people provided below. Please place them in the order to be contacted in an emergency, giving details of their relationship to your child. E.g. Aunt/Uncle, Grandparent, Family Friend, Child Minder etc.*

	Emergency Contact 1.	Emergency Contact 2.
Name
Address
Postcode
Contact Number
Can Collect (Y/N)
Relationship to Child

4. medical/health/send details

Details of Doctor*

	Doctors Name	Address	Contact Number

Medication required by child? Medication required by school? If you have indicated any medical needs, please give further details here (please indicate if the condition is serious as it may require a care plan) Please indicate any learning disabilities, including speech difficulties (plus details of any speech therapy) or any other problems which may affect your child’s learning.

Do we have permission to contact your doctor?*YesNo

Do we have permission to administer first aid where necessary?*YesNo

5. dietary requirements

Please select the diet which best reflects your child’s needs:* Does your child have any food allergies? If there are any food allergies, you are required to fill in a special diet form and the catering company requires a medical note from the doctors which allows them to cater to the child’s needs.*

6. additional funding

The Government is giving money to schools to help children from lower income families do their very best. This funding is called ‘Early Years Pupil Premium’. For every child registered Aldersbrook Primary School will receive a maximum of £300 this year (April 2020).  With this money we could provide:    Opportunities for funded learning support such as tuition and after school activities   Free music tuition    Reduced costs for educational visits and residential trips   Subsidised after school clubs     Subsidised Breakfast Club   A free book from the school Book Fair   Resources to support areas such as: Literacy, Mathematics and Knowledge and Understanding of the world   More interventions to accelerate your child’s academic progress   Interventions to develop self-esteem, self-confidence and social emotional skills. Who Qualifies for Free School Meals and Pupil Premium funding?  Free School Meals and Pupil Premium funding can only be awarded if you or your partner are claiming:   Income Support   Income-based Jobseeker’s Allowance   Income-related Employment and Support Allowance   Support under part VI of the Immigration and Asylum Act 1999   The guaranteed element of State Pension Credit   Child Tax Credit based on an annual gross income of no more than £16,190   Working Tax Credit run-on   Universal Credit Or your child has been:   Looked after by the Local Authority for at least one day, or is currently in care   Has been adopted from care   Has left care through special guardianship   Has been subject to child arrangement order setting with whom the child is to live (formerly known as residence orders)  How to apply Check if you qualify by looking at the list above Complete the form online on  www.redbridge.gov.uk/schools/free-school-meals/  Additional Information If you feel you meet the criteria, please complete the online form to initiate possible Pupil Premium funding for your child. Applications are confidential and it will not affect any other benefits you are claiming.   If you have any further questions or require support in applying, please contact Mrs Kari, Assistant Head Teacher for KS2 and Pupil Premium.

If you would like assistance with your application or to discuss this with a member of staff please tick here

7. consent

Please tick to consent:*Visits: We will contact you prior to a visit and the children will be supervised at all times. • I give permission for my child to be taken on school visits in the local area (Wanstead flats, Wanstead park, Wanstead high street, School allotment, Local library, Venue for school productions – the local church and Wanstead High School etc.)

Please tick to consent:*Digital and Media Permission: I give permission for my child to be involved in activities in school using digital media, videos, photographs and podcast (for examples: school website/displays/documents/video conferencing/local and national newspaper) • I understand that I may withdraw this consent at any time by writing to the officeOpt-out: I do not wish for my child to be included in images, videos or other digital media created in school and displayed as wider content. I give permission for my child to be involved but not for their image to be used.

Please tick to consent:*Attendance: In the event of my child’s absence, I will inform the school office before 9:30am • If for any reason my child is late for school but requires a school lunch, I agree to inform the school by 9:30am

Please tick to consent:*Behaviour: I agree to support the policies of the school and to encourage my child to follow the school golden rules and to behave with consideration to other people

8. declaration

Please Confirm*I have read and understood the content of this form. The information given on this form is correct.

Please Confirm*I understand that I MUST inform the school should the details given change.

Please confirm*I have read and understood the Home-School Agreement

Please confirm*I have read and understood the Online Safety Agreement

Confirmation - Primary Guardian 1*

	Digital Signature	Relationship to child

Confirmation - Primary Guardian 2

	Digital Signature	Relationship to child

Data Protection Act 1998

9. proof of identity and address

Please enter a valid email address to receive confirmation of submitted form:*