Netherhall Learning Campus High School

ADMISSIONFORM

STUDENT INFORMATION
LEGAL SURNAME / PREFERRED SURNAME
LEGAL FORENAME / PREFERRED FORENAME
MIDDLE NAME(S) / GENDER / Male / Female
DATE OF BIRTH / Date / Month / Year / Age
HOME ADDRESS
POSTCODE:
TELEPHONE NUMBER
DETAILS OF PARENTS/CARERS –Priority 1
PRIORITY 1
FULL NAME OF PARENT/CARER : / Title: / Mr / Mrs / Miss / Ms
Forename: / Surname:
RELATIONSHIP TO CHILD
(Mother/Father/Carer etc)
IMPORTANT: Please indicate clearly whether parent has parental responsibility for the child named above / Yes / No
HOME ADDRESS
If different to student
HOME TELEPHONE
MOBILE NUMBER
EMAIL ADDRESS
NAME OF EMPLOYER
WORK CONTACTNUMBER
Any special instructions for contacting you at work:
DETAILS OF PARENTS/CARERS – Priority 2
PRIORITY 2
FULL NAME OF PARENT/CARER : / Title: / Mrs / Mr / Miss / Ms
Forename: / Surname:
RELATIONSHIP TO CHILD :
(Mother/Father/Carer etc)
IMPORTANT: Please indicate clearly whether parent has parental responsibility for the child named above / Yes / No
HOME ADDRESS
If different to student
HOME TELEPHONE
MOBILE NUMBER
EMAIL ADDRESS
NAME OF EMPLOYER
WORK CONTACTNUMBER
Any special instructions for contacting you at work:
DETAILS OF OTHER CONTACTS (if applicable)
PRIORITY 3
FULL NAME OF OTHER CONTACT: / Title: / Mr / Mrs / Miss / Ms
Forename: / Surname:
RELATIONSHIP TO CHILD :
(Mother/Father/Carer etc)
HOME ADDRESS / POST CODE:
TEL NUMBER (IN CASE OF EMERGENCY)
PRIORITY 4
FULL NAME OF OTHER CONTACT: / Title: / Mr / Mrs / Miss / Ms
Forename: / Surname:
RELATIONSHIP TO CHILD :
(Mother/Father/Carer etc)
HOME ADDRESS / POST CODE:
TEL NUMBER (IN CASE OF EMERGENCY)
MEDICAL INFORMATION
NAME OF DOCTOR / NAME OF SURGERY
ADDRESS / TEL NO:
MEDICAL CONDITIONS
It is important that you read this section – Please give details of any medical condition/recurring complaint, of which you feel we should be aware. Please advise the school in writing of any changes concerning your child’s medical condition whilst he/she is a student at the school.
Please complete if your child has a medical condition.
Medical Condition / Please tick / Type of condition *Delete as appropriate / Allergic to? / Current Medication / Triggers / Individual symptoms
Allergy
(eg: penicillin, nut,
peanut,
latex,
insect,
sting, egg)
Asthma / *Mild
*Chronic
Diabetes / *Insulin dependent
Epilepsy
Any other medical condition.
Please fill in here as appropriate:
FOOD ALLERGIES
For the health and safety of our pupils it is important that we are made aware of any food allergies which your child may suffer from.
If we do not have this information on their records you could be putting your child’s health at risk.
If your child does suffer from food allergies, could you please advise us below. Could you also indicate what action should be taken if your child becomes ill due to an allergic reaction. If you require any prescribed medication to be kept in school could you please ensure that this is labelled clearly with your child’s name and taken to the school office. This request applies to all pupils, including those who bring a packed lunch, as there may be occasions when your child is involved in activities which include food tasting, etc.
ETHNIC INFORMATION
Asian or Asian British: / Mixed Dual Background:
Indian / White and Black Caribbean
Pakistani / White and Black African
Bangladeshi / White and Asian
Chinese / Asian and Black
Any other Asian Background / Other Mixed Background
Black or Black British: / White:
Black Caribbean / White – British
Black – African / White – Irish
Any other Black Background / Traveller of Irish Heritage
Other: / Gypsy/Roma
Any other Ethnic Group / Any other White Background
Refused
LANGUAGE & NATIONALITY
LANGUAGE SPOKEN AT HOME
STUDENTS FIRST LANGUAGE
Do you consider English to be an additional language for your child? / YES / NO
STUDENTS NATIONALITY
COUNTRY OF BIRTH
RELIGION
Christian / Muslim
Hindu / Sikh
Roman Catholic / Jewish
Buddhist / No Religion
Other Religion (Please State)
LUNCHTIME ARRANGEMENTS
Paid School Meal / Free School Meal / Packed Lunch
SERVICE CHILDREN IN EDUCATION
Is either parent serving in the regular HM military units (armed forces) – TA not included / Yes / No / Unknown
EDUCATION HISTORY
Name of current school:
MEDIA CONSENT
During your child’s time at Netherhall Learning Campus, the local newspaper or other external organisations may take photographs, video or sound recordings of students to be used in printed publications or on the internet, or for marketing purposes.
Before using any photographs, video or sound recordings of your child, we need your permission.
School Publications
May we use your child’s photograph, in printed publications produced by the school? / YES / NO
School Website
May we use your child’s photograph, video or sound recordings on the school website and on our social media platforms?
(Full names or personal identification will not be used)
Newspaper
May the press use your child’s photograph in the newspaper?
Please note by agreeing to this you are also giving your permission for the press to use the full name of your child in the paper and possibly also on their website.
Other organisations
May other external organisations use your child’s photograph, video or sound recordings in their publications or on their websites?
(Full names or personal identification will not be used)
Please note:
  • Websites can be viewed throughout the world, not just in the United Kingdom where UK law applies.
  • Consent is assumed to be indefinite, even when the student has left Netherhall Learning Campus High School. However you may change your permission at any time.
Name of Parent/Carer:______
Signature:______
Date:______

CONSENT FOR THE USE OF BIOMETRIC INFORMATION IN SCHOOL

Please complete this section if you consent to the school taking and using information from your child’s fingerprint by Netherhall Learning Campus High School as part of an automated biometric recognition system.

This biometric information will be used by NetherhallLearningCampusHigh School for the purpose of adding money to be used at breaktimes and lunchtimes in the school dining room.

In signing this form, you are authorising the school to use your child’s biometric information for this purpose until he/she either leaves the school or ceases to use the system.

If you wish to withdraw your consent at any time, this must be done so in writing and sent to the school at the following address:

NetherhallLearningCampusHigh School

Netherhall Avenue

Huddersfield

HD5 9PG

Once your child ceases to use the biometric recognition system, his/her biometric information will be securely deleted by the school.

Having read guidance provided to me by Netherhall Learning Campus High School, I give consent to information from the fingerprint of my childbeing taken and used by Netherhall Learning Campus for use as part of an automated biometric recognition system for catering for which this data will be used for break and lunchtimes to purchase items from the school dining room.

I understand that I can withdraw this consent at any time in writing.

Name of Parent/Carer:______

Signature:______

Date:______