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Please complete the following information.

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* 1. Child's Legal Surname

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* 2. Child's Legal Forename

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* 3. Child's Preferred Forename (known as)

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* 4. Child's Preferred Surname (known as)

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* 5. Child's date of birth

Date

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* 6. Gender

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* 7. Does your child have a sibling that attends Brentside High School?

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* 8. Home address

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* 9. Student contact mobile number

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* 10. Student nationality (as stated on passport)

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

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* 12. Please list the previous schools your child attended since they were 5 years old. Start with the most recent one.

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* 14. Does your child have any medical conditions?

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* 15. If 'yes', please provide details below

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

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* 17. If 'yes', please provide additional information

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* 18. Dietary requirements

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* 19. Does your child have any allergies?

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* 20. If 'yes', please provide additional information

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* 21. Does your child have any recurrent Illnesses?

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* 22. If 'yes', please provide additional information

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* 23. Does your child wear glasses?

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

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* 25. Does your child wear hearing aids?

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

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

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* 28. If 'yes', please provide contact details

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

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* 30. If 'yes', please provide the start and end dates

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* 31. Doctor and health centre information

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* 32. Parent/carer information (priority contact 1)

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* 33. Parent/carer information (priority contact 2)

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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.

For example, if your child was adopted from care, is currently or has ever been a Looked After Child, they 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 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 additional information

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* 40. Child born outside the United Kingdom (date of arrival in the UK)

Date

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* 41. What is the child'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. Consent for the use of photographs can be withdrawn at any time. This can be done by a written request to Ms Gent and Ms Miglior to info@brentsidehigh.ealing.sch.uk.

From this date, no further photographs will either be taken or circulated of you/your child based on the particulars of your request. Any photographs taken and circulated prior to withdrawal of consent will remain withstanding. Children 16 years or older can provide us with their own consent.

Please answer the following questions on consent:

I DO give consent for the use of my/my child's photographs/videos in displays within the school premises

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* 50. I DO give consent for the use of my/my child's photographs/videos within school publications (such as prospectuses)

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* 51. I DO give consent for the use of my/my child's photographs/videos within the school's official website

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* 52. I DO give consent for the use of my/my child's photographs/videos within the school's social media accounts (Facebook, Twitter etc.)

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* 53. I DO give consent for the use of my/my child's photographs/videos by local and national press

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

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* 55. I DO give consent for my child to be registered on the schools biometric cashless catering system

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* 56. I DO give consent for the school to email me about Parent Forum Meetings

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* 57. I DO give consent for the school to email me about Friends@Brentside (PTA) information and events

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* 59. 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.

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