New Starter Form (On-Line)

Child's surname* Child's first name* Other names Name by which child is known

Gender*MaleFemale

Date of Birth (please use drop down box)*

Brothers and sisters who currently attend Millbrook School
	Name	Class
Child 1
Child 2
Child 3

Previous playgroup/nursery or schools attended
	Name / address	Dates attended from / to
1
2
3

FAMILY AND EMERGENCY CONTACT DETAILS

WE MUST HAVE AT LEAST TWO CONTACTS IN CASE OF EMERGENCY.

Please let us know of any change in contact details as soon as possible. It is essential that the school can make contact with you quickly, if needed.

Please note in the case of parent separation, unless there is a Court Order, both parents should be detailed in order of priority.

First name* Surname* Address* Relationship to child* Home telephone number Mobile Number* Work number and extension (if applicable) Email address*

Are you a member of the Armed Forces*YesNo

Parent/Carer 2

Select one of the following*MrMrsMissMs

First name* Surname* Address* Relationship to child* Home telephone number Mobile telephone number* Work number and extension (If applicable) Email address

Are you a member of the Armed Forces*YesNo

Parent/Carer 3

Select one of the followingMrMrsMissMs

First name Surname Relationship to child Mobile telephone number

Parent/Carer 4

Select one of the followingMrMrsMissMs

First name Surname Relationship to child Mobile number

NAMES OF ADULTS WHO ARE PERMITTED TO COLLECT YOUR CHILD

In order to minimise security risks at the end of the school day, it is essential that the school know who is authorised to collect your child from school. It is expected that all children in KS1 or younger will be collected from the classroom and not from the gate.

It is strongly recommended, in most circumstances, that older brothers and sisters in the school do not collect younger siblings.

Please rate the following
	Name of adult	Relationship to child

Please tick*I understand that the school has a legal duty to report any safeguarding concerns to the relevant authorities without parental consent where there is a risk of harm.I further understand that, if my child is late being collected from school, then the school has a duty to inform the relevant authority, when this becomes persistent.

MODE OF TRANSPORT

OUTSIDE AGENCIES

Does your child have a Statement of Special Education Needs*Text 1item text

Has your family or child had contact with any of the following:-

Child Family Guidance Education Psychologist*YesNo

Educational Welfare Office*YesNo

Speech Therapist*YesNo

Child Development Centre*YesNo

Social Worker*YesNo

Other agencies/information the school need to be aware of (please specify)

MEDICAL INFORMATION

Are your child’s immunisations all up to date?

MMR*YesNo

Pre School Booster*YesNo

Does your child suffer from any of the following conditions?

Has your child had any serious illnesses/accidents that required hospitalisation : Other illnesses the school should be aware of (please specify)

Is your child taking regular prescribed medication at home (outside school hours)?

Select one of the following*YesNo

If so, please provide further information : Please provide any further concerns you would like to mention/on-going investigation for a medical condition :

ALLERGIES

If treatment is needed please provide further Information

ASTHMA QUESTIONNAIRE

Family Doctor Details*

Name of Practice / Surgery
Address
Telephone number

Can the GP be contacted for information when/if required?*YesNo

We comply with the requirements of the Hertfordshire Schools Asthma Policy and request that you complete an Asthma Maintenance Plan when your child joins the school, which will be updated each academic year.

Please visit https://www.bonneygrove.herts.sch.uk/form/?pid=13&form=260 and complete the on-line Asthma Questionnaire and ensure all medication is handed into the school office.

The information will be used by staff in school to provide appropriate care and support during school hours.

Inhalers must be clearly labelled with your child’ name and date of birth, and remind you that it is the parents/carers responsibility to ensure that inhalers are in date and replaced as needed. If your child has an inhaler in school we MUST also have a spacer for this in school.

Children are not permitted to have/carry any medication in their bag during the school day.

What triggers your child's asthma (if known )

Is your child’s asthma (please tick as appropriate)Mild – uses reliever blue inhaler occasionallyModerate – uses preventer and occasionally blue inhalerSevere – uses preventer, regular reliever and other medication

How many times (if any) has our child attended Accident & Emergency with an acute asthma attack in the past year?Not attendedOnce or moreState how many times below

Does your child have disrupted sleep due to his/her asthma (please tick as appropriate)RarelyOccasionallyFrequently

How often is your child seen by the hospital / GP/ Practice Nurse (please tick as appropriate)Only when he/she has an asthma attackOn a 3-6 monthly (or more frequent basis)Annual check by GP

What inhalers / medication has your child been prescribed?

Select one of the followingReliever (Name)Preventer (Name)Other (Name)

Children are not permitted to have/carry any medication in their bag during the school day.

MEAL ARRANGEMENTS

Does your child have a special medical dietary requirement (as confirmed by a GP) :*YesNo

Please provide additional information regarding your child's special medical dietary requirements as confirmed by a GP.

If your child has a special medical dietary requirement (as confirmed by a GP) parents/carers MUST apply on the Herts Catering Limited (HCL) website (https://specialmenu.hcl.co.uk/application/registration), before they will be able to have a meal in the school canteen. Please speak to the school office if you require any further guidance.

LANGUAGE DATA

A first language other than English should be recorded where a child was exposed to the language during early development and continues to be exposed to this language in the home or in the community.

If a child was exposed to more than one language (which may include English) during early development the language other than English should be recorded, irrespective of the child’s proficiency in English.

In the case of an older pupil who is no longer exposed to the first language in the home, and who now uses only another language, the pupil or parent can determine which language should be recorded.

Other Language .....(only use if your language is not listed above)

ETHNIC BACKGROUND

Our ethnic background describes how we think of ourselves. This may be based on many things including, for example, our skin colour, language, culture, ancestry or family history. Ethnic background is not the same as nationality or country of birth.

The DfES recommends that those with parental responsibility decide the ethnic background for primary pupils. The Information Commissioner (formerly the Data Protection Registrar) recommends that young people aged over 11 years old have the opportunity to decide their own ethnic identity. Parents, or those with parental responsibility, are asked to support or advise those children aged over 11 in making this decision, wherever necessary.

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