Bishop Alexander L.E.A.D. Academy - Pupil Information Form Survey

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* 3. Parent/Guardian 1

Name *

Address *

Address 2

City *

County

Postal Code *

Email Address

Phone Number *

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* 4. Parent/Guardian 2

Name *

Address *

Address 2

City *

County

Postal Code *

Email Address

Phone Number *

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* 5. Other

Name

Address

Address 2

City

County

Postal Code

Email Address

Phone Number

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* 6. Emergency Contact 1

Name *

Relationship to Child

Address *

Address 2

City *

County

Postal Code *

Phone Number *

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* 7. Emergency Contact 2

Name *

Relationship to Child

Address *

Address 2

City *

County

Postal Code *

Phone Number *

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* 8. Emergency Contact 3

Name *

Relationship to Child

Address *

Address 2

City *

County

Postal Code *

Phone Number *

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* 9. Pupil's Ethnicity

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* 10. Pupil's Religion

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* 11. Doctor's Name and Surgery Address

Doctor's Name *

Address *

Address 2

City *

County

Postal Code *

Phone Number

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* 12. Medical Conditions/Allergies

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* 13. Previous School (if applicable)

Please note: we will not allow your child to go with any other person unless you have let school know and given a password.

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* 14. Pick Up Name 1

Name

Phone Number

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* 15. Pick Up Name 2

Name

Phone Number

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* 16. Pick Up Name 3

Name

Phone Number

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* 17. Dietary requirements

Vegan

GF/Coeliac

Halal Meat

Non Diary

Vegetarian

Nut Free

Other

None

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* 18. I give permission for my child to use email and internet. I understand that school has a filtering system that controls access to age appropriate materials. Very rarely material gets through the filters but I understand that the school reports this and will inform me if this has happened. I understand that my child will follow school rules relating to safe use.

Yes

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* 19. I give permission for my child's photo to be used on displays, in books, on the school website and on school publications.

Yes

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* 20. I give permission for my child’s photo to be used in the local newspaper.

Yes

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* 21. I give permission for my child to watch PG films.

Yes

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* 22. I give permission for my child to have a plaster applied.

Yes

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* 23. I give permission for my child to be taken for emergency hospital treatment if we are unable to reach any of the emergency contacts given.

Yes

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* 24. I give permission for my child to take part in food tasting activities and I have already advised the school of any allergies.

Yes

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* 25. I give permission for my child to take part in local trips around Newark. This may be by bus or walking.

Yes