Student Information Form Please complete the following information. OK Question Title * 1. Legal Surname OK Question Title * 2. Legal Forename OK Question Title * 3. Preferred Forename (known as) OK Question Title * 4. Preferred Surname (known as) OK Question Title * 5. Date of birth Date of Birth Date OK Question Title * 6. Gender Male Female Other Other (please specify pronoun) OK Question Title * 7. Home Address Flat/House Number Street City Postcode OK Question Title * 8. Student Contact Mobile Telephone Number OK Question Title * 9. Student Nationality (Stated on Passport) OK Question Title * 10. What is the language you speak with your child currently at home? Arabic Chinese English French Italian Kurdish Nepali Panjabi Polish Russian Somali Spanish Urdu Other/multiple languages (please specify) OK Question Title * 11. Please list the previous schools attended since the student was 5 years old. Start with the most recent one. School 1 School 2 School 3 Other OK Question Title * 12. What language did your child study at Primary School French German Spanish Other (please specify) OK Question Title * 13. Does your child have any medical conditions Yes No OK Question Title * 14. If Yes please provide details below 1) 2) 3) OK Question Title * 15. Does your child require medication during the school day or in an emergency Yes No OK Question Title * 16. If "Yes" - please provide additional information OK Question Title * 17. Dietary Requirements Vegetarian (A vegetarian is someone who doesn't eat meat and fish) Vegan Dairy Free Gluten Free Other (please specify) OK Question Title * 18. Does your child have any allergies Yes No OK Question Title * 19. If Yes, please state in the box provided OK Question Title * 20. Does your child have any recurrent Illnesses? Yes No OK Question Title * 21. If Yes please provide information in the box provided OK Question Title * 22. Does your child wear glasses Yes No OK Question Title * 23. Is your child under the care of an eye specialist (excluding opticians) Yes No OK Question Title * 24. Does your child wear hearing aids Yes No OK Question Title * 25. Is your child under the care of an audiology or hearing clinic Yes No OK Question Title * 26. Is your child seeing a specialist or service for any of the above or other conditions Yes No OK Question Title * 27. If Yes, please provide contact details Name Company Address City/Town Postal Code Email Address Phone Number OK Question Title * 28. Has your child ever received Free School Meals? Yes No OK Question Title * 29. If "yes", please provide the start and end dates Start Date End Date OK Question Title * 30. Doctor and Healthcentre Information Name of Doctor Medical Practice Address Telephone Number NHS Number OK Question Title * 31. Parent/Carer Information (First Contact) Name Address Mobile Contact Number Work Contact Number Home Contact Number email address Relationship to the Child OK Question Title * 32. If your child does not have Free School Meals, but may be eligible because of your family’s income level, please provide the following information to register them. Even if you do not wish them to have the meals, this would mean the school could still claim Pupil Premium funding that may be used to help your child.Click here for Ealing Council FSM informationIn order to check if your child is eligible for Free School Meals or the Pupil Premium Grant we require your date of birth Date of birth Date OK Question Title * 33. In order to check if your child is eligible for Free School Meals or the Pupil Premium Grant we require your National Insurance Number OK Question Title * 34. We require at least 2 emergency contacts for your child. Please provide details below.Emergency Contact 1 (this might be a relative, friend or neighbour) Name Relationship Home Number Mobile Number Email Address Postal Address OK Question Title * 35. Emergency Contact 2 (this might be a relative, friend or neighbour) Name Relationship Home Number Mobile Number Email Address Postal Address OK Question Title * 36. Please provide any information regarding your child's family circumstances that you think we should be aware of. If your child was adopted from care or has ever been a Looked After Child he/she will be entitled to extra funding to support educational activities. OK Question Title * 37. Please provide any information regarding your child's progress in school to date (including any learning difficulties causing the parent/carer concern) OK Question Title * 38. Does your child have any other particular skills/talents, for example musical ability, sporting accomplishments etc. Yes No OK Question Title * 39. If Yes, please provide information in the boxes provided 1) 2) 3) OK Question Title * 40. Students born outside the United Kingdom (Date of arrival into the UK) Date Date OK Question Title * 41. What is the student's legal status regarding residence in the UK? Discretionary leave to remain Lawfully Resident Asylum Seeker UK/EU Citizen Other European Citizen Other (please specify) OK Question Title * 42. Is Brentside High School the first school your child will attend in the UK Yes No OK Question Title * 43. Which race/ethnicity best describes your child? (Please choose only one) Asian or Asian British Includes any Asian background, for example, Bangladeshi, Chinese, Indian, Pakistani Black, African, Black British or Caribbean (includes any Black background) Mixed or multiple ethnic groups (includes any Mixed background) White (includes any White background) Another ethnic group (includes any other ethnic group, for example, Arab) Prefer not to say Not Applicable OK Question Title * 44. Which one best describes your Asian or Asian British background? Bangladeshi Chinese Indian Pakistani Another Asian background Prefer not to say Not Applicable OK Question Title * 45. Which one best describes your Black, African, Black British or Caribbean background? African Caribbean Another Black background Prefer not to say Not Applicable OK Question Title * 46. Which one best describes your Mixed or Multiple ethnic groups background? Asian and White Black African and White Black Caribbean and White Another Mixed background Prefer not to say Not Applicable OK Question Title * 47. Which one best describes your White background? British, English, Northern Irish, Scottish, or Welsh Irish Irish Traveller or Gypsy Another White background Prefer not to say Not Applicable OK Question Title * 48. Which one best describes your background? Arab Another ethnic background Prefer not to say Not Applicable OK Question Title * 49. I DO give permission for photographs of my child to be used in the school’s own website/publications Yes No OK Question Title * 50. I DO give permission for photographs to be used in newspapers/television/Internet Yes No OK Question Title * 51. I DO give permission for my child’s details to be passed on to the Connexions Careers Advisory Services Yes No OK Question Title * 52. I DO wish my child to be registered on the schools biometric cashless catering system Yes No OK Question Title * 53. I DO give permission for the school to email me about Parent Forum Meetings Yes No Other (please specify) OK Question Title * 54. I DO give permission for the school to email me about Friends@Brentside (PTA) Information & Events Yes No OK Question Title * 55. Please select your child's religion Buddhist Christian Hindu Jain Jew Muslim Sikh No Religion Do not wish to say Other (please specify) OK Question Title * 56. I declare that the information given is correct. I understand that any false information given by me to the Governing Body could give rise to legal proceedings against me and to the withdrawal of the offer of admissions even after my child has joined the School. Please select the following to consent. I hereby agree with the Governors that they shall make such enquiries as they think fit to verify the information given in this application form. OK SUBMIT
