Family Details & Permissions 1. Family Details Question Title 1. I am the child's: Mother Father Primary Carer Other (please specify) Question Title 2. Mother's/Primary Carer's Title Miss Mrs Ms Mx Other (please specify) Question Title 3. Mother's/Primary Carer's Names First Name Surname Question Title 4. Contact for mother/primary carer (If providing overseas contact numbers, please type them as you would dial them from the UK.): Home telephone number Mother's mobile number Mother's work telephone Mother's e-mail address Question Title 5. Father's/Second Carer's Title Mr Mx Other (please specify) Question Title 6. Father's/Second Carer's Names First Name Surname Question Title 7. Contact for father/second carer (If providing overseas contact numbers, please type them as you would dial them from the UK.): Home telephone number Father's mobile number Father's work telephone Father's e-mail address Question Title 8. Home address: Line 1 Line 2 Line 3 Postcode Question Title 9. Who lives at the above address? Mother Father Mother and Father Other (please specify) Question Title 10. Parent's/Carers' Occupations Mother's/Primary Carer's Occupation Father's/Second Carer's Occupation Question Title 11. Parents'/Carers' Languages and Countries of Birth Mother's/Primary Carer's country of birth Mother's/Primary Carer's first language Other languages Mother/Primary Carer speaks Father's/Second Carer's country of birth Father's/Second Carer's first language Other languages Father/Second Carer speaks Question Title 12. Who has parental responsibility for your children? Mother Father Mother and Father Other (please specify) Question Title 13. Do you have any other children at Melcombe Primary? If so, please state their name and class. Name and class Name and class Name and class Name and class Name and class Question Title 14. Have any of your children ever attended Melcombe Primary? No Yes - please state name and year Yes - please state name and year Yes - please state name and year Question Title 15. Do you have any other children at other schools? If so, please state their name, age and school. Name, age and school Name, age and school Name, age and school Name, age and school Name, age and school Question Title 16. How many children are you enrolling today? 1 2 3 4 Question Title 17. Is one of the children being enrolled today going to be in the Nursery? Yes No 10% of survey complete. Next
