APPLICATION FOR ADMISSION TO
MILWARDS PRIMARY SCHOOL AND NURSERY
Note to parent or guardian
Please ask at the school if you need help in completing this form.
All information given will be treated in confidence.
Prior to starting school we need to see your child’s Birth Certificate.
Child’s full name: ……………………………………….. …………………………………………. ………………………
M / F Surname Other Names Date of Birth
Address: ………………………………………………………………………………….…………………………
DETAILS OF ADULTS LIVING WITH THE CHILD:
Mothers / Guardians full name: ……………………………………….. …………………………………
Surname First Name
Home Telephone: ………………………………. Day time number for emergencies ………………………
Fathers / guardians full name: ………………………………………… ………………………..………..
Surname First Name
Home Telephone: ……………………………… Daytime number for emergencies ………………………..
Please list other children in the family in age order and the schools they attend:
Surname First name Date of Birth School
1. …………………………………………………………… ……………………… ………………………….
2. …………………………………………………………… ……………………… …………………………
3. ……………………………….…………………….…….. .…..….……………… …………………………
Child’s Doctor ………………………………………………………………………….
Address …………………………………………………………………………………
Has your child have any allergies or medical problems we should know about?
………………………………………………………………………………………………………………………….
First Language used at home …………………. Family Religion …………………….Nationality …………….
Name and address of Previous School / Nursery ………………………………………………………………..
………………………………………………………………………………………………………………………….
If you have just moved into the area please give us your previous address:
…………………………………………………………………………………………………………………………
Are you entitled to Free School Meals: Yes / No
Are you in receipt of any of the following: Yes / No
· Income support
· Jobseekers Allowance (income based)
· Income related employment and support allowance
· Child tax credit with an annual taxable income of less than £16,190
· Pension Guarantee Credit
· Support under Part V1 Immigration and Asylum Act 1999
Please supply the following information regarding other adults who may be contacted in emergency situations. In order of preference.
Name ……………………………………………………………………… Telephone No ………………………
Relationship to child ………………………………Address …………………………………………………………
Name ……………………………………………………………………… Telephone No ………………………
Relationship to child ………………………………Address …………………………………………………………
DECLARATION OF PARENT/GUARDIAN
I declare that the above is a true statement of my child’s circumstances.
Signed: ………………………………………………….…………. Date: …………………………
Parent / Guardian
Please return to:
Headteacher, Milwards Primary School and Nursery, Paringdon Road, Harlow, Essex. CM19 4QX. Phone No. 01279 435850.
PARENTAL CONSENT
Please tick if you agree
I AGREE TO MY CHILD TAKING PART IN LOCAL VISITS, WHICH MAY OCCUR ON OCCASIONS
e.g. WALKS, LIBRARY, SHOPPING AND STEWARDS FOR THE OLDER CHILDREN.
I AGREE TO MY CHILD BEING PHOTOGRAPHED (INCLUDING VIDEO) DURING SCHOOL EVENTS, SUCH AS PLAYS, SPORTS DAYS AND ANY OTHER EVENTS BEING HELD ON OR OFF SITE, AS WELL AS OFFICIAL PHOTOGRAPHERS ARRANGED BY THE SCHOOL AND FOR THIS TO BE ON THE SCHOOL WEBSITE. I WILL NOT PERSONALLY UPLOAD ANY IMAGES TO SOCIAL NETWORK SITES. THIS IS IN ACCORDANCE WITH THE DATA PROTECTION ACT 1998.
I UNDERSTAND THAT IF MY CHILD SHOULD NEED EMERGENCY MEDICAL TREATMENT EVERY EFFORT WILL BE MADE TO CONTACT ME BEFORE TREATMENT IS GIVEN. IF, HOWEVER, THIS IS IMPOSSIBLE I GIVE MY CONSENT TO MY CHILD UNDERGOING EMERGENCY MEDICAL TREATMENT ON THE ADVICE OF A QUALIFIED MEDICAL PRACTITIONER.
I AGREE TO MY CHILD’S RECORDS BEING PASSED ONTO THE RECEIVING SCHOOL ON LEAVING.
SIGNED …………………………………………………………… DATE ……………………
FOR OFFICAL USE ONLY
DATE OF ADMISSION ……………………………….. YEAR …… CLASS ……..
BCS …………………….. OFFICE ……….………. COMP ……………….
We CHALLENGE you to be the best you can be