Student Information Collection
So that we can care in the best way possible for your child, please complete this form as fully as possible. Please note that this information is held under the Data Protection Act1998 for use within school and services related to your child’s education only.
Previous School
Student Details
Legal First Name: / Preferred First Name:Middle Names:
Legal Surname: / Preferred Surname:
Date of Birth: / Gender: / Male / Female
Addresses
Student’s current address: / Alternative address:
Postcode: / Postcode:
Home telephone: / Home telephone:
Siblings at Forge Valley
Name: / Form: / Year Group:
Name: / Form: / Year Group:
Name: / Form: / Year Group:
Bad Weather and Emergency Closures
Tick one box only and supply the emergency contact number you wish us to use if applicable.
Send my child home: / Send my child to a relative: / Contact me by phone:
Emergency contact number:
Parents / Carers / This should ONLY be an adult with parental responsibility for this child. Individuals named will receive communications/correspondence from the school. If you wish to add other adults please do so under Other Contacts.
First Contact (Priority 1) / Relationship: / Second Contact (Priority 2) / Relationship:
Title: / Title:
First Name: / First Name:
Surname: / Surname:
Address: / Same as student: tick / Address: / Same as student: tick
Or: / Or:
Postcode: / Postcode:
Communication
Note: We will make your mobile phone your Primary number for texting messages to you. If you wish us to use a works mobile number instead type ‘P’ in the appropriate box. If you have no mobile your land line will be used as your main contact number.
Land Line No: / Land Line No:
Mobile No: / Mobile No:
Work No: / Work No:
Note: The primary email addresses will be used to send email correspondence. If you wish to receive communication to only one email address DO NOT complete primary emails for both adults.
Primary e-mail: / Primary e-mail:
Other email: / Other email:
Important: A Court Order restricts access to student records and limits communication with that adult. You are required to inform us if such a Court Order exists.
Does a Court Order exist? / Yes / No / Does a Court Order exist? / Yes / No
Other Contacts – please only supply details for emergency purposes.
Third Contact (Priority 3) / Relationship: / Fourth Contact (Priority 4) / Relationship:
Title: / Title:
First Name: / First Name:
Surname: / Surname:
Address: / Address:
Postcode: / Postcode:
Home No: / Home No:
Mobile No: / Mobile No:
Work No: / Work No:
e-mail: / e-mail:
Does a Court Order exist? / Yes / No / Does a Court Order exist? / Yes / No
Medical Information
Permission is given for the school to act in case of a medical emergency. / No / Yes
Dietary Needs:
Any specific food allergy?
The School’s Food Service will tailor meals for students with confirmed allergies. Confirmation is required from your GP. You should then contact the School’s Food Service direct on 0114 234 8805 Ext 81022617
Tick any of the dietary requirements as appropriate…
Gluten free / No dairy foods / No nuts
Halal / Kosher only / No pork
Does your child currently receive any treatment from the following professionals?
Occupational therapy / Physiotherapy / Speech therapy
Medical Practice
Practice Name:
Address:
Sheffield / Postcode:
Doctor’s Name (in full if possible): / Doctor’s Telephone:
Medical Conditions
Details are kept of on-going conditions and temporary medical needs. Please keep us up-to-date as this information helps our First Aider to support your child in school. The information is also used when organising educational visits although updates will be requested for residential trips and adventure activities prior to the activity date.
Does your child take medication for long term or intermittent medical conditions? / Yes / No
If yes, please provide details in the table below.
Medical Condition (& Details) / Administering any medication (name, timing, dosage) / Side effects
Does your child suffer from allergic reactions other than food, e.g. to penicillin, to pollen? / Yes / No
If yes, please specify.
Wearing of Spectacles
My child has a current prescription for lenses which assist with vision. / Glasses should be worn: / Contact lenses are worn:
Ethnic/Cultural / For Ethnicity check the table below.
Ethnicity: / Religion:
Home Language:
Country of Birth: /
/ First Language:
Nationality: /
Ethnicity Categories
Any other Asian background / Chinese / White and black African
Any other black background / Gypsy / White and black Caribbean
Any other ethnic group / Roma / White British
Any other mixed background / Other Gypsy/Roma / White Eastern European
Any other white background / Indian / White Irish
Bangladeshi / Other Black African / White Pakistani
Black Caribbean / Pakistani / White traveller of Irish heritage
Black Somali / White and any other Asian background / Yemeni
For a pupil with one parent from one ethnic group, and the other parent of mixed heritage who shares a common ethnicity with the first parent, the most important factor identifying ethnicity is how the child (or his/her family) sees his/her ethnic origin. The common category (e.g. within ‘Black or Black British’) would normally be what is selected; however, this may not be the case with pupils with one white parent and one mixed heritage parent.
Additional Information
Mode of Travel: / Car / Cycle / School Bus / Public Bus / Taxi / Tram / Walk
Tick ONE mode of travel only. This should represent the most frequently used mode of travel.
Once your child is aged 13 or over, we are required by law to pass on certain information to the provider of youth support services in our area. This data includes the address of you and your child (their date of birth) and any further information relevant to the support services' role. The data can however, be limited to name, address and date of birth. Please indicate your acceptance of the full service or the more limited information below:
Youth Support Services Agreement: / Use any necessary information / Limit the information as above
We are required to keep a record of children who are members of a *Service Family. You do not need to offer any further information nor indicate which parent is in service. * A Service Family has one or both parents as a member of the armed forces (Army, Navy or Air Force). It does not include the Police, Fire or Ambulance Service.
Is your child part of a Service Family as defined above? / No / Yes
Welfare - Disability
Is this child in Local Authority Care? / No / Yes
Is your child officially recognised as a carer for a member of your family? / No / Yes / If yes, please give starting date…
You may give brief details here…
Is your child registered disabled? / No / Yes / If yes, please give registration date…
You may give brief details here…
Parental Consents
As part of your child’s school record we take a photograph of their head and shoulder, only, for identification purposes. Students may be photographed in a school activity or educational visit for the purposes of publication in the school prospectus or on the school’s website. Photographs used in such a manner will not show the student’s name. Similar reasoning and examples apply to videoing. Students will be told the purpose for the taking of any additional photograph or video recording.
Consent types / Permission given / Permission NOT given
We agree to the exchange of our child’s data for educational purposes, e.g. exam boards, Department for Education (DfE), etc.
(I have read and understand the Privacy Notice – see back of this form.)
My child may have a finger scan for cashless catering. (Only useable by school)
My child may use the Internet as guided by the teacher in school.
My child may participate in Video Conferencing
My child may participate in curriculum based School Visits
If you choose not to give permission you will be issued with a Parental Consent Form for every trip or activity for which your child is invited to participate.
My child may participate in Sex Education lessons
My child may be photographed (e.g. during lessons, on visits) for use in school publications, primarily school prospectus, newsletters and the school website.
My child may be videoed in school (e.g. drama events) for use on the school network and the school website.
Please confirm that the information supplied is applicable to the child named on this form. The adult signing below must have parental responsibility for the child.
Signed: / Parent/carer (please print):
Relationship to child: / Date:
For School Use
Registration Group: / House:
Year Group: / Year taught in:
Registration: / Single / Dual – Main / Dual - Subsidiary / Guest
Privacy Notice - Data Protection Act 1998
We, Forge Valley School, are a data controller for the purposes of the Data Protection Act. We collect information from you and may receive information about you from your previous school and the Learning Records Service. We hold this personal data to:
· Support your teaching and learning;
· Monitor and report on your progress;
· Provide appropriate pastoral care, and
· Assess how well we are doing.
Information about you that we hold includes your contact details, national curriculum assessment results, attendance information and personal characteristics such as your ethnic group, any special educational needs you may have and relevant medical information. If you are enrolling for post 14 qualifications the Learning Records Service will give us your unique learner number (ULN) and may also give us details about your learning or qualifications.
Once you are aged 13 or over, we are required by law to pass on certain information to providers of youth support services in your area. This is the local authority support service for young people aged 13 to 19 in England. We must provide the names and addresses of you and your parent(s), and any further information relevant to the support services’ role. We may also share data with post 16 providers to secure appropriate support on entry to post 16 provision.
However, parent(s) can ask that no information beyond names, addresses and your date of birth be passed to the support service. This right transfers to you on your 16th birthday.
Please inform the MIS & DataManager(0114 2348805 ext: 2609) if you wish to opt out of this arrangement. For more information about young people’s services, please go to the National Careers Service page at
https://nationalcareersservice.direct.gov.uk/aboutus/Pages/default.aspx
We will not give information about you to anyone outside the academy without your consent unless the law and our policies allow us to.
We are required by law to pass some information about you to the Department for Education (DfE) and, in turn, this will be available for the use of the Local Authority.
If you want to receive a copy of the information about you that we hold and/or share, please contact the MIS & Data Manager (0114 2348805 ext. 2609).
If you need more information about how the Local Authority (LA) and/or DfE store and use your information, then please go to the following websites:
http://www.sheffield.gov.uk and
http://media.education.gov.uk/assets/files/doc/w/what%20the%20department%20does%20with%20data%20on%20pupils%20and%20children.doc
If you are unable to access these websites we can send you a copy of this information. Please contact the LA or DfE as follows:
· First Point
Sheffield City Council
Howden House
1 Union Street
Sheffield
S1 2SH
· Public Communications Unit
Department for Education
Sanctuary Buildings
Great Smith Street
London
SW1P 3BT
Website: https://www.gov.uk/government/organisations/department-for-education
email: http://www.education.gov.uk/help/contactus
Telephone: 0370 000 2288
Forge Valley School – New Entrant Form (Sept 2017)