Ethnic Origin/Please see attached sheet *Language spoken at home *
Dit svar
Religion *
Dit svar
All Previous Schools Attended
Please include name of school, town, date admitted and date left
Previous Schools *
Dit svar
Emergency Contact Details
Please give details of who should be contacted in an emergency in priority order. Please note that all texts from school will be sent to priority number one.
Contact 1 *
Please include name, relation to student, day time address and daytime phone number or mobile
Dit svar
Contact 2 *
Please include name, relation to student, day time address and daytime phone number or mobile
Dit svar
Contact 3
Please include name, relation to student, day time address and daytime phone number or mobile
Dit svar
Parent Details
Please give details of all persons with parental responsibility for the student.
Parent details - Contact 1 *
Please include name, relationship to student, address, occupation and place of work and telephone number or mobile for text alerts.
Dit svar
Parent details - Contact 2
Please include name, relationship to student, address, occupation and place of work and telephone number or mobile for text alerts.
Dit svar
Parent/Parents ever served full time in the Armed Forces? *
Pupil Nationality *
Dit svar
Pupil Country of Birth *
Dit svar
Medical Details
Name of Doctor *
Dit svar
Name of Surgery *
Dit svar
Details of any medical condition, including any long-term medication. *
If this box is filled in, we will contact you at a later date for further information.
Dit svar
Free School Meals
Please tick appropriate boxes
Does student receive free school meals at present school? *
Will student be eligible for free school meals at Wellfield Middle School? *
Please tick this box if you would like to find out if you are eligible for free school meals
Please tick this box if your child has been adopted from care
Please tick this box if you require duplicate reports (i.e. parents live at different addresses)
Brothers/Sisters
Please give details of all brothers and sisters of the student
Please include name, date of birth, school (if at school) and school year (if at school)
Dit svar
Equality Monitoring Form
The Government requires schools to monitor and report on the progress of students from all ethnic groups and those with other protected characteristics (as defined by the Equality Duty 2010). This information will assist us in ensuring that we have equal access for everyone and allow us to work to remove any barriers as well as to eliminate discrimination and harassment. Would you please fill in the relevant sections below and add any further details that you think may be appropriate?Completion of this information is entirely voluntary. Any information will be kept strictly confidential, if however you have any needs or concerns that you wish to discuss or for the school to address you may wish to contact us direct. The categories for ethnic monitoring are those used by the Government in the 2011 census.
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