Admissions Form 2016
Welcome to
The Langley Academy Primary
To help us prepare to admit your child, please complete this Admission Form, in as much detail as possible.
Forms should be returned by 9th May 2016 to:
Mrs T Bowen
The Langley Academy Primary
Langley Road
Slough
SL3 7EF
You may return your form by post or deliver it in person to the Security Officer at the main gate.
Alternatively, you can return the form via email to:
If you have any queries, please telephone Mrs Wingrove on 01753 214450
For September 2016 Page 1 of 8
Admission/ Data Collection FormPlease complete all sections of this form and sign the back page. Thank you.
Pupil Details:Legal
Surname: / Legal
First Name: / Middle
Name:
Preferred Surname:
(if different from above) / Preferred First Name:
(if different from above)
Date of Birth: / Gender: Male / Female (circle)
Home Address:
House No/Name: / Street:
District: / Town:
County: / Post Code:
Home Telephone No:
Details of Parent/Carer(s):
We are required by law to keep a register of all parents of pupils at The Langley Academy Primary. This includes natural and adoptive parents and carers, all of who are entitled to vote in elections for academy governors, etc, even if they do not have custody of the child.
Title
(Mr/Mrs/Ms) / First Name / Surname / Mobile Telephone No. / Work Telephone No.
Email Address
(very important to complete this as this is how we communicate with parents) / Profession/Occupation
Address (if not same as pupil’s Home Address)
Relationship to Child / Parental Responsibility
Yes / No
Title
(Mr/Mrs/Ms) / First Name / Surname / Mobile Telephone No. / Work Telephone No.
Email Address
(very important to complete this as this is how we communicate with parents) / Profession/Occupation
Address (if not the same as pupil’s Home Address)
Relationship to child / Parental Responsibility
Yes / No
To whom should letters be addressed?
Emergency Contacts:
Please indicate below, in order of preference, who should be contacted in the event of illness or other emergency during school hours.
Title / Name / Surname / Address
(if not as above) / Telephone Number
(Home, Work, Mobile - if not as above) / Relationship to Child
Medical Information:
Name of Doctor’s Surgery/Health Centre:
Address:
Post Code:
Telephone No:
Medical Information on your child, eg: medical condition / disability / allergies (e.g. asthma, diabetes) / ADHD / Asthma / Eczema / Other:
Allergies (detail) / Diabetes / Epilepsy
Please give details of any medication your child is required to carry or hold at school e.g. Inhaler, Epipen
Sibling Information:
Does your child have any siblings? YES / NO
If yes, please list details / Sibling 1 / Sibling 2 / Sibling 3 / Sibling 4
Name of brother or sister
Date of Birth
School / Year Group
Previous Education:
Please list previous schools attended with dates. (Please include Nursery Schools or Pre-Schools/Playgroups)
Use the right-hand column to give details of any special educational provision etc.
School
(Name & Address) / From:
(DD/MM/YYY) / To:
(DD/MM/YYYY) / NOTES
ETHNIC & CULTURAL
Please take the time to answer these questions to help us see that your child and other children get the best out of their schooling. The government has asked schools/academies to collect this information – but you do not have to give it unless you want to. Any information you do give will be treated in strict confidence. This part is about ethnic background. It is not citizenship or nationality. Please tick the ethnic group which your child belongs to.
Please tick one box only.
ETHNICITY / CODE / / ETHNICITY / CODE /
BANGLADESHI / ABAN / ANY OTHER MIXED BACKGROUND / MOTH
INDIAN / AIND / WHITE AND ASIAN / MWAS
ANY OTHER ASIAN BACKGROUND / AOTH / WHITE AND BLACK AFRICAN / MWBA
PAKISTANI / APKN / WHITE AND BLACK CARIBBEAN / MWBC
BLACK AFRICAN / BAFR / INFORMATION NOT YET OBTAINED / NOBT
BLACK CARIBBEAN / BCRB / ANY OTHER ETHNIC GROUP / OOTH
ANY OTHER BLACK BACKGROUND / BOTH / REFUSED / REFU
CHINESE / CHNE / WHITE BRITISH / WBRI
ANY OTHER WHITE BACKGROUND / WOTH / WHITE IRISH / WIRI
GYPSY/ROMA / WROM / TRAVELLER OF IRISH HERITAGE / WIRT
Languages Spoken (please appropriate box/es):
Language / Speak / Read / Write / Language / Speak / Read / Write
Arabic
Specify: / Hindi
Bengali / Polish
Cantonese / Urdu
Spanish / Punjabi
French / Another Language Specify:
English / Another Language Specify:
English as an Additional Language / YES / NO
Pupils First Language (Please Specify)
Pupils Home Language(s) (Please Specify)
Religion (please appropriate box)
Please tick one box only. Some religions may have more than one denomination. If you wish, you can say which denomination on the space at the bottom of this section.
Buddhist / Muslim
Christian / Sikh
Hindu / Other (Please specify):
Jewish / No Religion
Refused
Nationality (Please State):
Recent Arrivals:
Date of Arrival in the UK: Country of Origin:
Equality Questionnaire
The Equality Act places a duty on public bodies to:
- Promote equality
- Eliminate discrimination that is unlawful under the DDA (1995)
- Eliminate disability related harassment
- Promote positive attitudes
- Encourage participation
- Take steps to meet disables people’s needs
NB A child has a disability if she/he has a physical or mental impairment which has a substantial and long term adverse effect on his/her ability to carry out normal day to day activities. The term ‘disability’ includes medical conditions such as heart disease, diabetes, severe disfigurement, depression, schizophrenia, dyslexia, epilepsy, Downs Syndrome, physical and sensory impairments. It also includes learning difficulties such as SpLD (Dyslexia, Dyspraxia etc), ADD, ADHD, MLD, SLD, SLCN, ASD (including Asperger’s Syndrome).
SEND / Yes / No / Description/Details
Has an Education Health Care Plan (Statement of Education Needs)
Behavioural Difficulties
Has been diagnosed as ADHD
Has social difficulties
Has Asperger’s / Autistic Spectrum Disorder
Has physical disability
Has been diagnosed with Dyspraxia
Has been diagnosed as epileptic
Has speech and language difficulties
Has hearing impairment
Has visual impairment
Moderate Learning Difficulty
Severe Learning Difficulty
Has any other SEND difficulty
ADDITIONAL INFORMATION
Lunchtime Arrangements /Dietary Needs
1. Academy Meal / Gluten Free / Seafood Allergy / Halal (No Pork)
2. Packed Lunch / No Wheat / Artificial Colouring
Allergy / Observes Sikh Diet
(No Beef)
No Dairy Produce / Vegetarian / Kosher
No Nuts of any type/quantity / Other Please Specify:
Transport to the Academy
(Please note you cannot drive in to The Langley Academy Site to drop off or collect your child. Cars should park around Trelawney Avenue and walk along Green Drive to access The Langley Academy Primary).
1. Walking / 5. Train
2. Cycling / Scooter / 6. Taxi
3. Car / 7. Other
4. Bus
Pupil Photographs
I understand that The Langley Academy Primary may take photographs of pupils at the Academy and use these images in the prospectus as well as on the website or on project display boards around the Academy. From time to time, the Academy may be visited by the media who will take photographs at certain events. Pupils will often appear in the images, which may appear in local or national newspapers or on televised news programmes. I give permission for my child to be included in these photographs when necessary. / Agree
Disagree
Local Walks
As part of the curriculum and responding to children’s learning, The Langley Academy Primary may take children on local walks, such as a walk to Trelawney Avenue shops or the local post box. Supervision requirements will always be considered. I give permission for my child to be included in any local walks or visits.
(This does not include permission for school trips/enrichment visits that are further from school). / Agree
Disagree
Emergency Medical Consent
I agree to my son/daughter receiving medication as instructed and any emergency dental, medical or surgical treatment, including anaesthetic or blood transfusion, as considered necessary by the medical authorities present. I understand the extent and limitations of any insurance cover provided. / Agree
Disagree
Safeguarding
The Langley Academy takes the safeguarding of its Pupils very seriously. It is the responsibility of the legal parent/carer to inform the academy in writing of any issues that may compromise the safety of Pupils. i.e. Sole Contact/Court Orders etc.
A separate form authorising people to collect your child will be issued to you for completion.
Additional Information
Please make any notes which might be useful about your child/ family on this page. For example information relating to SEN issues, EAL, concerns regarding health. What do they enjoy or are good at, dislikes or difficulties, friends and sibling etc.
Supporting documentation required
Proof of Address Details (please circle)
Birth Certificate / Photocopied / To Follow
Utility Bill / Photocopied / To Follow
I understand that The Langley Academy Primary will refer to the information provided on this form for activities both on and off site. I confirm that I will inform The Langley Academy Primary of any changes to this information immediately, so the safety of my child is not compromised.
Signed:______(Parent/Carer)
Print Name:______
Date: ______
Email Address:______
FOR ACADEMY USE (Further Notes / Information)
Admission No: / UPN:
Admissions Date: / Registration Group:
For September 2016 Page 1 of 8