Reception Starters Form.
Please complete this form by 12noon on Monday 10th July, for your child starting Reception in September 2023.

This form is confidential to staff concerned with your child's education and is covered by GDPR.

Many thanks
Nick Moss (Headteacher)

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1, Surname* *
2, Legal Surname* *
3, Forename* *
4, Middle Name* *
5, Chosen Name* *
6, Child's Date of Birth* - Please input as month,day,year. *
7, Gender* *
8, Year Group *
9, Class Teacher* *
10, Full Address including postcode* *
11, Mobile Number* *
12,Home telephone number
13, Email Address* *
14, Please give details of all persons who have parental responsibility and anyone else you wish to be contacted in an emergency.  Please place them in order that you wish for them to be contacted in an emergency.  Please give your answers in priority order in questions 15,16,17
15, Priority Contact 1 - Please include full name, relationship to child, full address and postcode, mobile/work/home telephone numbers and email address.* *
16, Priority Contact 2 - Please include full name, relationship to child, full address and postcode, mobile/work/home telephone numbers and email address.*
 *
17, Priority Contact 3 - Please include full name, relationship to child, full address and postcode, mobile/work/home telephone numbers and email address.*
 *
18,Travel Arrangements to and from school* *
19, Meal Arrangements* 
(this can be a mixture of school dinner and packed lunch during the week)
 *
20, Does your child has any dietary needs?* *
21, Registered medical practice details * *
22, Please give details of any medical conditions* *
23, Please use this box to detail any medical notes for your child * *
24, Do you consider your child to have any disabilities* *
25, If Yes, please give details below
26, Ethnicity* *
27, Religion* *
28, Home Language* *
29, First Language* *
30, Nationality*
31, Country of Birth* *
32, Do you give permission for your child to be included in photos for our school newsletter, website, social media?* *
33, Do you give permission for your child to be included in photo's for your local press?* *
34, From time to time we take children on a local school visit, i.e to the Church on the Common, or to the library.  Please indicate if you are happy for your child to go on a local supervised visit.*
Clear selection
35, Please inform us of any relevant after school care arrangements for your child, e.g. details of child minder/details of shared parental custody (it is important that we know who will normally be responsible for picking up your child). 
I have already provided the school office with a copy of my child's birth certificate. (the school office can photocopy this for you if required) *
Please summarize your child's pre-school experience e.g  Nursery setting or other setting attended *
Child's Hand Preference *
Please make us aware of any known physical/medical or pastoral information .  This information will enable us to fully support your child at school. e.g impaired hearing, wears glasses, unclear speech, glue ear, bed wetting, hospitalisation, premature birth, fears, referrals, parental separation, recent bereavement.  My Plan/My Plan plus, social care. Please ensure you advise the school office
Any other relevant information
36, Signature* *
37, Date* - month, day, year *
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