Please complete the following information.

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* 1. Legal Surname

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* 2. Legal Forename

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* 3. Preferred Forename (known as)

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* 4. Preferred Surname (known as)

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* 5. Date of birth

Date

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* 6. Gender

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* 7. Home Address

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* 8. Student Contact Mobile Telephone Number

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* 9. Student Nationality (Stated on Passport)

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* 10. What is the language you speak with your child currently at home?

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* 11. Please list the previous schools attended since the student was 5 years old.  Start with the most recent one.

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* 13. Does your child have any medical conditions

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* 14. If Yes please provide details below

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* 15. Does your child require medication during the school day or in an emergency

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* 16. If "Yes" - please provide additional information

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* 17. Dietary Requirements

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* 18. Does your child have any allergies

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* 19. If Yes, please state in the box provided

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* 20. Does your child have any recurrent Illnesses?

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* 21. If Yes please provide information in the box provided

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* 22. Does your child wear glasses

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* 23. Is your child under the care of an eye specialist (excluding opticians)

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* 24. Does your child wear hearing aids

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* 25. Is your child under the care of an audiology or hearing clinic

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* 26. Is your child seeing a specialist or service for any of the above or other conditions

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* 27. If Yes, please provide contact details

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* 28. Has your child ever received Free School Meals?

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* 29. If "yes", please provide the start and end dates

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* 30. Doctor and Healthcentre Information

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* 31. Parent/Carer Information (First Contact)

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* 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 information

In order to check if your child is eligible for Free School Meals or the Pupil Premium Grant we require your date of birth

Date

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* 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

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* 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)

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* 35. Emergency Contact 2 (this might be a relative, friend or neighbour)

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* 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.

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* 37. Please provide any information regarding your child's progress in school to date (including any learning difficulties causing the parent/carer concern)

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* 38. Does your child have any other particular skills/talents, for example musical ability, sporting accomplishments etc.

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* 39. If Yes, please provide information in the boxes provided

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* 40. Students born outside the United Kingdom (Date of arrival into the UK)

Date

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* 41. What is the student's legal status regarding residence in the UK?

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* 42. Is Brentside High School the first school your child will attend in the UK

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* 43. Which race/ethnicity best describes your child? (Please choose only one)

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* 44. Which one best describes your Asian or Asian British background?

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* 45. Which one best describes your Black, African, Black British or Caribbean background?

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* 46. Which one best describes your Mixed or Multiple ethnic groups background?

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* 47. Which one best describes your White background?

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* 48. Which one best describes your background?

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* 49. I DO give permission for photographs of my child to be used in the school’s own website/publications

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* 50. I DO give permission for photographs to be used in newspapers/television/Internet

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* 51. I DO give permission for my child’s details to be passed on to the Connexions Careers Advisory Services

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* 52. I DO wish my child to be registered on the schools biometric cashless catering system

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* 53. I DO give permission for the school to email me about Parent Forum Meetings

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* 54. I DO give permission for the school to email me about Friends@Brentside (PTA) Information & Events           


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* 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.

0 of 56 answered
 

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