In order to carry out its ordinary duties to staff pupils and parents the School may process a wide range of personal data about individuals as part of its daily operation. Please refer to the School Data Protection Policy for information on how the School processes personal data.

Please complete the form as fully as possible. All * questions must be completed.

Parent name (completing this form) *
Child's Full Name *


Which school year is your child joining?
EG R, Y1,Y5 *
Date of Birth *
Doctor's Name *
Doctor's Address *
Doctor's Telephone Number *


Gender *

Allergies

For allergies, please provide details of testing to confirm diagnosis, and copies of any management plans.

Does your child have any allergies?
If YES, please list them below, include food, drugs, plants, animals. *
Please give details:

For Asthma, please see the School Nurse for an Asthma Allergy plan

Is your child receiving any treatment, for any medical, condition? *
Please give details:


Does your child take any medication? *


Please give details:

A Medication Administration form, available from the School Nurse or Welfare Officer, MUST be completed by the parent/guardian. Medication sent from home will only be administered if prescribed by a doctor.

3. Is there any reason why your child cannot participate in Physical Education? *
Does your child have any visual difficulties? *
Has your child had any previous difficulties with hearing? *

Previous Illness

Please indicate, by filling in an approximate date (MM/YY), which illnesses your child has had.

Asthma
Epilepsy or Seizures
Eczema
Hayfever
Heart, joint, muscle problems
Please list any others
Has your child ever been hospitalised (operations/injuries/illnesses)? *
Is there any history of physical or mental illness which might have a bearing on your child's health? *

Immunisation History : Please indicate if your child has immunisations.

Pre School Booster
(Whooping cough, Diptheria,Polio,Tetanus) *
Please give the date of Immunisation.
(dd/mm/yy) *
MMR (measles, mumps, rubella) *
Meningococcal C vaccine *

Dietary and Pre Travel Health

Does your child suffer from travel sickness? *
Please provide further details, medication used etc.
My child cannot eat
(please tick all that apply)
No meat is Halal *

Your child is not permitted to participate in Field Trips or any Athletic activities until this form is complete and submitted to the School Nurse or Welfare Officer.

Typically the legal recommendation for how long to keep pupil personal data is up to 7 years following departure from the school. There will be instances when the School is legally required to hold this data for longer. There might be instances when the School uses good judgement to deem it reasonable to hold data for longer.

Thank you for filling this in.

Please leave the next box blank or your submission will not be accepted: