Pre Admission Form

Please complete without any blanks (n/a if no data). 

It is absolutely vital that the school has emergency contact details for you. Please list all available phone numbers, including a number that is always contactable.

Pupil’s surname
(known by)		Legal surname		
Pupil’s forename(s)		Date of birth		
Known by (if different from forename)				

Pupil’s address
(inc. post code)		

Please give details of all persons who have parental responsibility for this pupil and anyone else to be contacted in an emergency.

Priority	Salutation, full name and relationship to pupil	Home Details	Work Phone
Number	Mobile
Number	
1	Mrs/ Miss/ Ms / Mr / Dr 

Full name:

Relationship:	Address:

 
Tel:
 			
2

	Mrs/ Miss/ Ms / Mr / Dr 

Full name:

Relationship: 	Address:

Tel:
			
3	Mrs/ Miss/ Ms / Mr / Dr 

Full name:

Relationship: 	Address:

Tel: 

please continue overleaf

Parent/guardian’s e-mail addresses (please print clearly). By providing an e-mail address, you will receive updates and you will be able to get parent access to your son/daughters VLE.

1. Name___________________________________ Email address ________________________________

2. Name___________________________________ Email address ________________________________

3. Name___________________________________ Email address ________________________________

	Please note that 2 different email addresses are required if both parents want separate access to the school VLE. 

Pupil’s doctors surgery		

Medical conditions		
Does your son/daughter receive extra time in exams - please give details		

Entitled to free school meals          Yes / No (delete as appropriate)

Main mode of travel to and from school (state only one)   ____________________________

Ethnicity
(please state white English,Scottish etc. NOT white British)		

Home Language		First Language		

Country of Birth		Nationality
(passport)		
Second nationality
(if dual nationality)		

Data Protection Act 1998:  The school is registered under the Data Protection Act for holding personal data. The school has a duty to protect this information and to keep it up to date. The school is required to share some of the data with the Local Authority and with the DfE.

Parent/Guardian Signature:	Date: