School Admission Form

Pupil’s Surname:* First Name:* Date of Birth:* Birth Certificate:*

Gender:*BoyGirl

Date of Admission: Home Address:* Postcode* Home Tel Number:*

Mother/Carer’s Full Name:

TitleMrMissMs

Forename:* Surname:* National Insurance number (for Free School Meals Eligibility checks)* Mother's Date of Birth (For free school meal eligibility check)* Mobile Number:* Work Number: Email address:* Mother’s home address if different:

Father/Carer’s Full Name:

Forename:* Surname:* National Insurance number (for Free School Meals Eligibility checks)* Father's Date of Birth (For free school meal eligibility check) Mobile Number:* Work Number: Email address:* Father’s home address if different:

Second Contact Name:

Home Tel Number: Mobile Number: Are there additional carer’s/residence orders: Who will collect your child from school? Any other information related to home that school should know: Name and Date of Birth of Brothers/Sisters:

Medical Information

Doctors Name, Medical Practice, Address and Telephone Number:*

Medical Conditions:

If other, please specify:

Any additional Educational Support given in the previous school?*YesNo

Has the child been on the Special Needs Register:*YesNo

Lunch Arrangements: (Please tick)*Packed LunchHot LunchLunch provided by school (if entitled to Free School Meals)

Please state any special dietary requirements that your child has, eg Halal, vegetarian

Is either parent in the armed forces?*YesNo

Are you receiving Income Support/Universal Credit?*YesNo

Are you a Refugee?*YesNo

Are you an Asylum Seeker?*YesNo

Have you or your child been known to Children/Social Services?*YesNo

Language

What is your family’s home language

Which language does your child use most often at home?

	Add text here:
1
2
3
4

School History

Please give the name of any Nursery Playgroup attended by your child:

	Name and address of Nursery	Start date	Leaving date

Tel No. Please give the name of School(s) attended by your child:

	Name and address of school	Start date	Leaving date

Tel No. What is your child’s nationality? What is your child’s country of birth? What do you consider to be your child’s ethnic origin?

Mixed:White and AsianWhite & Black AfricanWhite & Black CaribbeanOther

Black or Black British:AfricanCaribbeanOther

Any Other Ethnic Background:Other

If you have selected Other, please specify

I do not wish an ethnic background category to be recorded

What is your child’s religion?

If you have selected Other, please specify

Do you have internet access at home?*YesNo

Does your child have access to a tablet or other device for online learning?*YesNo

Declaration

The information on this form is accurate:*Please click to confirm

Print name* Date*

Belmont School Privacy Notice for Pupils (information we hold relating to your child) can be found on the school website. All personal data/special category data submitted herein are processed in accordance with UK data