Deanesfield Reception Admissions - September 2020

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* 1. Pupil Details

Legal Forename

Legal Surname

Date of Birth (DD/MM/YYYY)

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* 2. Address

House Number

Street

Town

Postcode

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* 3. Please state child's previous school/playgroup or NA if not attending a setting previously:

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* 4. Does you child have any siblings currently attending Deanesfield Primary School?

Yes

If you answered 'Yes' above, please give the name(s) and class(es) of the siblings.

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* 5. Parent 1 Contact Details

Title

Forename

Surname

Date of Birth (DD/MM/YYYY)

Mobile Phone Number

Home Phone Number

E-mail address

National Insurance (NI) Number

Home Address (if different to pupil's address)

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* 6. Parent 2 Contact Details

Title

Forename

Surname

Date of Birth (DD/MM/YYYY)

Mobile Phone Number

Home Phone Number (if different to above)

E-mail address (if different to above)

National Insurance (NI) Number

Home Address (if different to pupil's address)

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* 7. Emergency Contact Details

Full Name

Phone Number

Relationship to Child

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* 8. Dietary Requirements (please specify i.e. vegetarian, halal, no beef etc.)

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* 9. Medical Details

Doctors Name

GP Surgery

Phone Number

Medical Conditions (e.g. allergies / asthma etc)

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* 10. Further Pupil Details

Ethnicity

Religion

Child's First Language

Child's Home Language

Country of Birth

Nationality

Date arrived in the UK (if born outside the UK)

Does your child speak English?

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* 11. Is your child in foster care / adopted?

Yes

If you answered 'Yes' above, please state the name and contact number of your social worker and the local authority.

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* 12. Do you or the child's other parent serve in regular military units (e.g. Army, Navy, Air Force)?

Yes

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* 13. Are you entitled to claim pupil premium funding for your child? (To check your eligibility or to register, please log on to https://pps.lgfl.org.uk)

Yes

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* 14. Is your child eligible and in receipt of Disability Living Allowance (DLA)?

Yes

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* 15. Does your child have any Special Educational Needs (SEND)?

Yes

If you answered 'Yes' above, please state your child's Special Need(s).

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* 16. By submitting this form, you are digitally signing the paperwork and agree it is accurate.

Name:

Relationship to child:

Date (DD/MM/YYYY)