Pupil Data Collection Form

1. Pupil Details

Legal Surname*

Forename*

Middle Name

Chosen Name*

Sex*

Date of Birth*

Address*

Post Code*

2. Medical Information

Surgery Address*

Surgery Number*

Medical Details*

Dietry Needs*

Allergy*

3. Lunch Arrangements

Monday

Tuesday

Wednesday

Thursday

Friday

4. Photographs

I give permission for the school to take pictures/videos of my child, I understand that these images will only be used for publicity to celebrate successes and to promote the schools work via the following means:-

Facebook/Twitter

School Website

Newspaper

School Displays

School Correspondance

I do not give permission at all

5. Who else will collect your child?

Person 1

Name

Relation

Person 2

Name

Relation

Person 3

Name

Relation

Person 4

Name

Relation

6. Contact Details

Person 1

Title*

Full Name*

Parent Responsibility*

Y

N

Relation to Pupil*

Home Phone*

Mobile*

Work Phone

Address*

Post Code*

Preferred Language to Communicate*

E-Mail*

Person 2

Title

Full Name

Parent Responsibility

Y

N

Relation to Pupil

Home Phone

Mobile

Work Phone

Address

Post Code

Preferred Language to Communicate

E-Mail

Person 3

Title

Full Name

Parent Responsibility

Y

N

Relation to Pupil

Home Phone

Mobile

Work Phone

Address

Post Code

Preferred Language to Communicate

E-Mail

If you are a human, do not fill in this field

If any changes occur to the information on this form, please contact the school as soon as possible so we can update on our system. Failure to do so can put your child at risk, or miss out on important information/correspondence from the school.