New starter data forms

Child's details

	Please complete below:
First name (full legal name)
Last name of child (full legal name)
Middle names (full legal names)
Preferred forename (if different)
Preferred last name (if different)
Gender (male/female)
Date of birth (DD/MM/YYYY)
Current school and postcode
Full postal address, including post code
Name of any siblings at Horsell Junior

Name of person completing questionnaire: Relationship to child: Email address: Please give details of all persons who have parental responsibility and anyone else you wish to be contacted in an emergency. Place them in order that you wish for them to be contacted in an emergency.*

	Contact 1
Title
First name
Last Name
Relationship to child
Home address
Home telephone number
Mobile telephone
Work number (if applicable)
Email address
Parental responsibliity (Yes/No)
Would like to receive school communications (Yes/No)

	Contact 2
Title
First Name
Last Name
Relationship to child
Home address
Home telephone number
Mobile telephone
Work number (if applicable)
Email address
Parental responsibility (Yes/No)
Would like to receive school communications (Yes/No)

Please provide a third contact, to be contacted in an emergency should the school not be able to contact contacts 1 and 2:*

	Contact 3
Title
First Name
Last Name
Relationship to child
Home telephone number
Mobile telephone
Permitted to collect child from school (yes/no)

Additional contact (optional, e.g. child minder, relative, family friend):


Title
First Name
Last Name
Relationship to child
Home telephone number
Mobile telephone
Permitted to pick up from school (Yes/No)

GP surgery your child is registered to:* If you answered other above, please write the full name, address and phone number of your doctor's surgery below: Please list any medical conditions below. If they require any medicine to be held in school, please visit the link provided at the end of the questionnaire and complete a Medication Request Form. If your child has as formally diagnosed special educational need, please provide details below: Other dietary requirements or additional information: Ethnic/cultural details*

	Please enter
Ethnicity
Nationality
Country of birth
First/home language
Additional languages spoken at home
Religion

Please let us know if any of the following apply to your child:May be entitled to free school meals (please see additional form below)Is a young carerIs a service child (parents/carers are in the armed forces)Is part of the Gypsy, Roma or traveller communityIs a refugee / asylum seeker

Home School Agreement

I have read and agree to support my child and the school as outlined in the Home School Agreement attached below:*

Consent to visit local area:

I agree to allow my child off the school premises during the school day for class activities in the local area.* I agree that my child can use the school's ICT and internet systems when appropriately supervised by a member of school staff. I have read and agree to the conditions set out in the the school's ICT and Internet Systems agreement for pupils, attached at the end of the questionnaire.*

Acceptable use of school's ICT and Internet Systems agreement

I have read the school's ICT and internet systems agreement for pupils with my child, and will ensure they understand the conditions. My child agrees to follow the conditions set out within the agreement.

PTA Consent

I agree that my email address and/or phone number can be passed directly to the Class Representative(s) of my child’s class for the purpose of informing me of any information which is relevant to my child’s class (for example, but not limited to social events, obtaining volunteers for class/school events, information about Parent Teacher Association events).

I understand that my email address/phone number will be shared with other parents/carers of my child’s class in the circulation of such emails and text/Whatsapp messages by the Class Representative. I agree that my email address/phone number is stored and passed to the Class Representative for each year that my child is in attendance at the Horsell Junior School. I am also aware that I can withdraw my information at any time.

	Yes	No
I agree to sharing my phone number with the PTA
I agree to sharing my email address with the PTA

Photo and Video Consent

I have read Horsell Junior School's photo and video policy attached at the end of this questionnaire and consent to my child being photographed and videoed for use on the school's:*

	Yes	No
Website
Twitter feed
Facebook
Newsletters (please note a copy is uploaded to our website)
Prospectuses, flyers, leaflets and brochures
Other promotional school material (such as banners, signs and displays)
In and around the school building
In promotional materials to show the history of the school
To photographs being taken of my child (individual and group photos) by the school photographer. The group photos will be made available for other parents to purchase

I have read Horsell Junior School's photo and video policy attached at the end of this questionnaire and consent to my child being photographed and videoed for use on the school's:*

	Yes	No
My child’s image may be taken, and used, by external providers e.g. National Trust, residential trip venues, museums.
I promise that if I, or members of my family, take photographs or video recordings these will be kept for family use and will not be uploaded to social media including WhatsApp.:

Additional information:

Please enter any additional information you wish us to be aware of:

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