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* Child’s Legal Surname

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* Child's Legal Forename

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* Preferred Surname

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* Preferred Forename

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* Middle name(s)

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* Date of Birth:

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* Gender

Please give details of brothers/sisters who are attending/have previously attended our school

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* Name

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* Class

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* Name

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* Class

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* Name:

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* Class

Address of Child

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* House No

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* Street

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* Town

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* Postcode

As part of ‘Keeping Kids Safe in Education’, we require details of at least 2 people who can be contacted in an emergency. If you wish to give more than 3 emergency contacts please add them below.)
DETAILS OF FIRST CONTACT

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* Surname

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* Forename

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* Title

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* Mobile No

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* Work Place Tel No

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* Email Address

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* Which number should we contact first?

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* Notes (e.g. mornings only etc.)

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* Home address

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* Postcode

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* Home Tel No

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* Please indicate Relationship to child

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* Does the above named contact have Legal Parental Responsibility for the child?

DETAILS OF SECOND CONTACT

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* Surname

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* Forename

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* Title

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* Mobile No

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* Work Place Tel No

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* Email Address

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* Which number should we contact first

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* Notes (e.g. mornings only etc.)

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* Home address

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* Postcode

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* Home Tel No

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* Please indicate Relationship to child

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* Does the above named contact have Legal Parental Responsibility for the child?

OTHER EMERGENCY CONTACT DETAILS

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* Surname

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* Forename

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* Title

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* Gender

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* Home Tel No

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* Work Place Tel No

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* Mobile No

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* Which number should we contact first

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* Notes (e.g. mornings only etc.)

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* Home address

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* Postcode

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* Please indicate Relationship to child

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* Does the above named contact have Legal Parental Responsibility for the child?

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* IS THE STUDENT

STUDENTS BORN OUTSIDE THE EUROPEAN UNION

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* Passport Number

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* Issue Date

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* Expiry Date

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* Name on Passport

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* Visa Number

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* Visa Expiry Date

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* DINNER ARRANGEMENTS

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* Free School Meal Claim Number

EDUCATIONAL HISTORY - PREVIOUS SCHOOL

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* Address

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* Start Date

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* Leaving Date

Data Protection
Under the terms of Data Protection Act 2018 and General Data Protection Regulation (GDPR) we must inform you that by signing this form you are giving your consent for Leeds City Council and Woodkirk Academy to process the data.

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* Declaration

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* SIGNATURE(S) (of person(s) who have legal parental responsibility for this student)

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* Date

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