STUDENT/FAMILY INFORMATION
(Please return the attached Information Form to Mark Hall Academy)

The Academy uses a computerised system to keep student records. It is very important that we have full and up to date information on your child, particularly in the case of emergency.

NOTES TO HELP WITH THE COMPLETION OF THE STUDENT ENTRY FORM

DETAILS OF PERSONS WHO HAVE PARENTAL RESPONSIBILITY

These are the people to whom all information, reports etc. about students are sent.

EMERGENCY CONTACT

These are the people whom we should try to contact if there is an emergency, e.g. your child is ill. Please put them in the order in which you wish them to be contacted.

MEDICAL INFORMATION

This should be a brief account of any medical details that it might be useful for the Academy to have on record. If you need more space please use a separate sheet.

ETHNIC ORIGIN please choose from:

WhiteBritish
Irish
Traveller of Irish Heritage
Gypsy/Roma
Any other White background
Albanian (excluding Kosovan)
Italian
Kosovan
Turkish/Turkish Cypriot
White Eastern European
(including Bulgarian, Czech, Latvian, Lithuanian, Polish, Romanian, Russian, Slovak, Ukranian)
White Western European
(including French, German, Spanish, Portuguese, Scandinavian)
White other
(other pupils of White background not represented in the categories above) / Mixed/Dual BackgroundWhite and Black Caribbean
White and Black African
White and Asian
(including White and Bangladeshi, White and Pakistani, White and any other Asian background)
Any other mixed background
White and any other ethnic group
Other mixed background
(Other mixed race pupils not represented in the categories above, including Asian and Black, Asian and Chinese, Asian and other ethnic group, Black and Chinese, Black and other ethnic group, Chinese and other ethnic group)
Black or Black BritishCaribbean
(including Antigua and Barbuda, Bahamas, Barbados, Dominica, Grenada, Guyana, Jamaica, St Kitts and Nevis, St Lucia, St Vincent + Grenadines, Trinidad and Tobago)
African
Nigerian
Other Black African
(including Angolan, Black South African, Ethiopian, Ghanaian, Rwandan, Sierra Leonian, Somali, Sudanese, Ugandan, Zimbabwean)
Any other Black background
(other pupils of Black background not represented in the categories above, including Black Canadian, Black European, Black North American) / Asian or Asian BritishIndian
Pakistani
(including Mirpuri Pakistani and other Pakistani)
Bangladeshi
Any other Asian background
Nepali
Other Asian
(Other Asian pupils not represented in the categories above, including East African Asian, Kashmiri, Sinhalese, South African Asian, Sri Lankan Tamil)
Chinese
Hong Kong Chinese
Other Chinese
(Other Chinese pupils not represented in the category above including Malaysian Chinese, Singaporean Chinese, Taiwanese)
Any other ethnic backgroundAfghanistani  Thai
Filipino  Vietnamese
Any other ethnic group
(pupils of ethnic backgrounds not represented in the categories above including, Palestinian, Kuwaiti, Jordanian, Saudi Arabian, Egyptian, Iranian, Iraqi, Japanese, Korean, Kurdish (from Iraq, Iran, Turkey), Central American, South American, Cuban, Belize, Lebanese, Malaysian (other than Malaysian Chinese), Moroccan, Polynesian, Fijian, Tongan, Samoan, Tahitian, Yemeni)
I do not wish an ethnic background category to be recorded

HOME LANGUAGE please choose from:

Akan/Twi-Fante
Albanian/Shqip
Amharic
Arabic
Bengali
Bengali (Sylheti)
British Sign Language
Caribbean Creole English
Caribbean Creole French
Chinese
Cornish
Danish
Dutch/Flemish / English
Finnish
French
Gaelic (Scotland)
Gaelic (Irish)
German
Greek
Gujarati
Hebrew
Hindi
Igbo
Italian
Japanese / Korean
Kurdish
Lingala
Luganda
Manx Gaelic
Norwegian
Panjabi
Pashto/Pakhto
Persian/Farsi
Polish
Portuguese
Romany/English
Romanes / Russian
Serbian/Croation/Bosnian
Sinhala
Somali
Spanish
Swahili/Kiswahili
Swedish
Tagalog/Filipino
Tamil
Turkish
Urdu
Vietnamese
Welsh/Cymraeg
Yoruba

RELIGION please choose from:

Buddhist
Christian / Jewish
Muslim / Hindu
Sikh / No Religion
Other (please specify)

MODE OF TRAVEL please choose the most commonly used:

Car Share
Car / Van / Dedicated Bus Service
Public Bus Service / Other
Taxi / Train
Walk

PERMISSION TO USE PHOTOGRAPHS

On occasions students may be photographed whilst taking part in a lesson or activity or whilst on anAcademy trip. The Academy likes to use these photographs in our Newsletters or display them on noticeboards around the Academy. Occasionally we send them to the local press for publication.

If you do not wish your child’s photograph to be used in any of the above you must write to the Academy to withdraw permission.

If you would like any further help with the filling in of this form, please phone the Academy and ask to speak to Mrs Cocksedge.

Yours sincerely,

Mrs G Cocksedge

Principal’s PA