PUPIL INFORMATION: Academic Year 2016/2017
SURNAME
Date of Birth
FORENAME(S)
ADDRESS
Tel. Number
Post Code
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PARENTS/GUARDIANS CONTACT INFORMATION
1.
Tel. Number
Mobile Number
Email Address
2.
Tel. Number
Mobile Number
Email Address
ADDITIONAL CONTACTS (in order of priority)
1.
Name
Tel. Number
Address
Relationship to Pupil (i.e. parent, grandparent, friend etc)
2.
Name
Tel. Number
Address
Relationship to Pupil (i.e. parent, grandparent, friend etc)
3.
Name
Tel. Number
Address
Relationship to Pupil (i.e. parent, grandparent, friend etc)
FAMILY DOCTOR
Name
Tel. Number
Address
PLEASE CONTINUE OVERLEAF
This information will be used on a computerised form. The school is registered under the Data Protection Act to keep such
information. Pupil data will be used for statutory returns to the Local Authority and registered Government Agencies.
PAEDIATRIC CONSULTANT
Name
Tel. Number
Address
NAME OF SOCIAL WORKER
Name
Tel. Number
Address
OTHER MEDICAL CONSIDERATIONS (i.e. eyesight, hearing impairment, allergies or conditions such as
epilepsy, diabetes, heart conditions, gastrostomy tube etc)
ANY DIETARY REQUIREMENTS
PREVIOUS SCHOOL
ETHNICITY
PLEASE CIRCLE THE FOLLOWING CHOICES AS APPROPRIATE
White – British
White – Irish
Any other White
background
Mixed – White &
Black Caribbean
Mixed – White &
Black African
Mixed – White &
Asian
Any other mixed
background
Indian
Pakistani
Bangladeshi
Any other Asian
background
Caribbean
African
Any other Black
background
Chinese
Any other ethnic
background
I do not wish an ethnic background
category to be recorded
RELIGION
PLEASE CIRCLE THE FOLLOWING CHOICES AS APPROPRIATE
Christian
Sikh
Hindu
Muslim
PLEASE CIRCLE THE FOLLOWING CHOICES AS APPROPRIATE
English
Punjabi
Hindi
Bengali
Gujarati
Other – please specify
IS ENGLISH A SECOND LANGUAGE
YES / NO
NAME:
(Please print)
SIGNED:
Pupil File
FE Dept
Roman Catholic
Other – please specify
HOME LANGUAGE
Urdu
Jewish
DATE:
Office
PE
(This section for office use only)
Classroom
HT
DHT
Medical
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