School Jotter - Surveys

Please complete and submit the information below as soon as possible. All data is collected in line with the Data Protection Act (2018) and the General Data Protection Regulation (2018). We look forward to welcoming your child in September.

PLEASE COMPLETE ALL FIELDS- USE N/A IF NOT APPLICABLE

Details of the pupil:

Q1. Legal Forename :

Q2. Middle name(s):

Q3. Legal Surname:

Q4. Chosen name (if different to above):

Q5. Gender:

Female

Male

Other

Please provide details below

Q6. Date of Birth:

Q7. Home Address

Street :

Town :

Postcode :

Telephone No. :

Q8. Please provide details (Name & D.O.B) of any siblings who are attending or have previously attended our school:

Q9. Previous Nursery/Pre School details :

Name of Nursery/Pre School:

Address:

Start & leaving date :

Contact details : Please provide details for at least 2 people who can be contacted in an emergency. As a parent/carer you have sought permissions from your emergency contacts to share their data with school.

Q10. Contact 1

Title :

First Name :

Surname :

Relationship to child (e.g mother/father/step-parent) :

Address (If different to above):

Daytime Telephone No.

Daytime place (if not home):

Mobile No :

Email address :

Contact priority no. (eg 1st, 2nd)

Q11. Does Contact 1 have legal parental responsibility?

Yes

Q12. Contact 2:

Title :

First Name :

Surname :

Relationship to child (e.g mother/father/step -parent) :

Address (If different to above) :

Daytime telephone No :

Daytime place (if not home) :

Mobile No. :

Email address :

Contact priority no. (eg 1st, 2nd)

Q13. Does Contact 2 have legal parental responsibility?

Yes

Q14. Contact 3:

Title :

First Name :

Surname :

Relationship to child (e.g mother/father/step-parent) :

Address (If different to above) :

Daytime telephone no. :

Daytime place:

Mobile no. :

Email address :

Contact priority no. (eg 1st, 2nd)

Q15. Does contact 3 have legal parental responsibility?

Yes

Q16. Contact 4:

Title :

First Name :

Surname :

Relationship to child (e.g mother/father/step-parent) :

Address (if different to above) :

Daytime telephone no. :

Daytime place (if not home) :

Mobile no. :

Email address :

Contact priority no. (eg 1st, 2nd)

Q17. Does contact 4 have legal parental responsibility?

Yes

FREE SCHOOL MEAL INFORMATION:

If you are the parent, foster parent, network family carer or guardian of children at school and you are on a low income, you could be entitled to free school meals for any full days your child attends nursery. It is important that you notify school if you believe your child is entitled to a Free School Meal due to low family income. If this is the case, school will be able to claim additional funding from the DfE to support your child.

Further information and the application form to claim free school meals can be found on the Leeds City Council website - https://www.leeds.gov.uk/residents/council-tax-and-benefits/free-school-meals

Q18. Is your child entitled to Free School Meals due to your financial circumstances? (see information above)

Yes

Q19. Meal choice:

School Meal

Packed Lunch

Free School Meal Eligible

Medical Information :

Q20. Doctor's Name :

Q21. Surgery address :

Q22. Surgery Telephone no. :

Q23. Medical conditions/allergies :

Great Preston C of E Primary School Application for Admission - Nursery