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Student Details
Legal Surname
*
Legal Forename
*
Middle Name(s)
Preferred Forename
Date of Birth
*
Sex
*
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Male
Female
Current School
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Details First Parent/Carer
Title
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Mr
Mrs
Ms
Miss
Other
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Full Name
*
Relationship
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Parent
Step Parent
Carer
Other
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Details Second Parent/Carer
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Mr
Mrs
Ms
Miss
Other
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Name
Relationship
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Parent
Step Parent
Carer
Other
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No 1 Contact
Title and Full Name
*
Address Including Postcode
*
Email
*
Relationship to Student
*
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Parent
Step Parent
Carer
Other
If Other, please state
Home Telephone Number
Mobile Number
*
Work Number
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No 2 Contact
Title and Full Name
*
Address Including Postcode
*
Email
*
Relationship to Student
*
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Parent
Step Parent
Carer
Other
If Other, please state
Home Telephone Number
Mobile Number
*
Work Number
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No 3 Contact
Title and Full Name
Address Including Postcode
Relationship to Student
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Parent
Step Parent
Carer
Other
If Other, Please State
Home Telephone Number
Mobile Telephone Number
Work Telephone Number
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Siblings
Name
Form
Name
Form
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Welfare
Is the student in care?
*
Yes
No
Has the student ever been in care?
*
Yes
No
Is the student adopted? (Evidence required if Yes)
*
Yes
No
Is student registered as a carer with Herts Young Carers
*
Yes
No
Does either parent serve in the armed forces?
*
Yes
No
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Ethnic Background
White Backgrounds :
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British
Irish
Traveller from Irish heritage
Gypsy/Roma
Italian
Turkish
Any other White background
Black or Black British Background :
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Caribbean
African
Any other Black background
Asian or Asian British Background :
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Indian
Pakistani
Bangladeshi
Any other Asian background
Mixed Ethnic Background :
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White and Black Caribbean
White and Black African
White and Asian
Any other mixed background
Chinese :
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Chinese
-
Any Other Ethnic Group please specify below
I do not wish an ethnic background to be recorded
If your child's first language is anything other than English, please indicate below.
I do not wish a first language to be recorded
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Medical
Name of Family Doctor
*
Telephone Number
*
Surgery
*
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Conditions
Conditions
Has the student ever had a hospital admission for a head injury?
*
Yes
No
If yes to above, please provide here approximate date and brief details.
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Dietary
Please indicate below if your child has any dietary needs:
Artificial Colouring Allergy
Gluten Intolerant
Halal
Vegetarian
Lactose Intolerant/No Dairy Produce
Nut Allergy
No Pork
Seafood Allergy
Other: please specify
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Health And Safety: Medication To Students
Link to:
Medical Conditions Support Policy
I acknowledge receipt of the school’s "Medical Conditions Support Policy" and agree with its contents.
*
Confirm Email
Trips and Visits Policy
I agree that my child may participate in any short visits to local venues which may be arranged during their time at the school and acknowledge the need for my child to behave responsibly whilst participating in any visit or activity.
*
I do not give consent for my child to attend Short Visits To Local Venues Which May Be Arranged During Their Time At The School
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Image Consent
I give permission for my child’s image to be used as outlined above
*
Yes
No
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Biometrics
Please tick one box only...
*
I give consent
I do not give consent
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Electronic signature
Name of parent completing form
*
Dated
*
I confirm that the information provided is true and correct.
*
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