FOSSILS APPLICATION FORM

Please complete one application form for each child.

CHILD’S DETAILS:
Name
Class / Date of Birth
PARENT/CARER DETAILS:
Name / Relationship to child
Home Address / Home No.
Mobile No.
Emergency Contact No.
ALTERNATIVE CONTACT DETAILS:
Name / Relationship to child
Home Address / Home No.
Mobile No.
Emergency Contact No.
Please detail any condition staff should be aware of (health problems, allergies, cultural & religious needs):
MEDICAL CONTACT DETAILS
Surgery Address / Doctors Name
Telephone No.
Who is authorised to collect your child from FOSSILS?
Is there anyone specifically who should not gain access to your child?
N.B. If you require anyone else to collect your child other than those above named, we must have your authorisation in writing before collection.
In the event of an accident I hereby give my consent for a trained member of staff to administer first aid or to seek emergency medical advice or treatment on my behalf.
Name / Relationship to child
Signed / Date

DATA PROTECTION

The information you provide will only be used by the staff. This form will be destroyed at the end of your child’s time with us or upon receipt of a new form.

Form continues overleaf….

PHOTOGRAPHS

During your child’s time at FOSSILS, we may wish to take photographs of activities that involve your child. The photographs may be used for displays, publications and on a website by us, by the Local Authority, by local newspapers or occasionally by national Government agencies.

I give*/do not give* permission for photographs of my child to be used for school displays or to accompany work submitted to college by visiting students or staff (e.g. Student teachers, Teaching Assistants undertaking NVQ training).

I give*/do not give* permission for my child to be photographed by the media or for school publications, e.g. school prospectus and website.

I understand that photography or filming will only take place with the permission of the Headteacher, and under appropriate supervision. When filming or photography is carried out by the news media, children will only be named if there is a particular reason to do so (e.g. they have won a prize), and home addresses will never be given out. Images that might cause embarrassment or distress will not be used nor will images be associated with material on issues that are sensitive.

INTERNET AND E-MAIL

I give*/do not give* permission for my child to use the internet and e-mail in accordance with the school’s Internet Access Policy. I understand that the school will ensure that children using the internet or e-mail are supervised at all times and that a suitable Internet Service Provider is used.

Name / Relationship to child
Signed / Date

* Please delete as appropriate.

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