PERSONAL INFORMATION RECORD
Sign in to Google to save your progress. Learn more
Email *
CHILD'S DETAILS
Please complete in full
CHILD'S CLASS *
CHILD'S SURNAME: *
CHILD'S FORENAME(S): *
NAME BY WHICH CHILD IS KNOWN: *
CHILD'S DATE OF BIRTH: *
MM
/
DD
/
YYYY
CHILD'S ADDRESS: *
CHILD'S GENDER: *
PARENTAL INFORMATION
Please complete in full
PARENT 1 FULL NAME: *
PARENT 1 FULL ADDRESS *
RELATIONSHIP TO CHILD: *
PARENT 1 EMAIL ADDRESS: *
PARENT 1 MOBILE PHONE NUMBER: *
PARENT 1 HOME PHONE NUMBER:
PARENT 1 WORK PHONE NUMBER:
PARENT 2 FULL NAME:
PARENT 2 FULL ADDRESS
RELATIONSHIP TO CHILD
PARENT 2 EMAIL ADDRESS
PARENT 2 MOBILE NUMBER
PARENT 2 HOME NUMBER
PARENT 2 WORK NUMBER
EMERGENCY CONTACT INFORMATION
In the event of an emergency or illness we will contact parents in the first instance, on the telephone number given above.  Please give the name, relationship to your child, and telephone number of two further contacts who may be reached to act on your behalf and may be required to collect your child from school in such circumstances.
EMERGENCY CONTACT NUMBER 1 FULL NAME (DIFFERENT FROM PARENT CONTACT) *
RELATIONSHIP TO CHILD *
MOBILE PHONE NUMBER *
HOME PHONE NUMBER
WORK PHONE NUMBER
EMERGENCY CONTACT NUMBER 2 FULL NAME (DIFFERENT FROM PARENT CONTACT) *
RELATIONSHIP TO CHILD *
MOBILE PHONE NUMBER *
HOME PHONE NUMBER
WORK PHONE NUMBER
I CAN CONFIRM THAT I HAVE OBTAINED PERMISSION FROM THE ABOVE NAMED EMERGENCY CONTACTS TO SHARE THEIR CONTACT DETAILS WITH YOU *
Required
FAMILY INFORMATION
PLEASE LIST THE NAMES AND DATES OF BIRTH OF OTHER CHILDREN IN THE FAMILY
NAME (CHILD 1):
DATE OF BIRTH (CHILD 1):
MM
/
DD
/
YYYY
NAME (CHILD 2):
DATE OF BIRTH (CHILD 2):
MM
/
DD
/
YYYY
NAME: (CHILD 3):
DATE OF BIRTH (CHILD 3):
MM
/
DD
/
YYYY
NAME (CHILD 4):
DATE OF BIRTH (CHILD 4):
MM
/
DD
/
YYYY
MEDICAL INFORMATION
Please provide full details
NAME OF DOCTOR *
TELEPHONE NUMBER OF DOCTOR: *
ADDRESS OF SURGERY: *
MEDICAL DETAILS *
Required
MY CHILD HAS THE FOLLOWING MEDICAL OR HEALTH ISSUES OR ALLERGIES (PLEASE GIVE DETAILS)
IN THE CASE OF ANY CHANGES TO MY CHILD'S MEDICAL NEEDS I WILL INFORM THE SCHOOL IMMEDIATELY *
Required
FIRST AID
I GIVE PERMISSION FOR MY CHILD TO BE GIVEN FIRST AID BY A TRAINED MEMBER OF STAFF.  I ALSO GIVE PERMISSION FOR A MEMBER OF STAFF TO SIGN ON MY BEHALF ANY MEDICAL CONSENT FORMS, IF MY CHILD SHOULD REQUIRE EMERGENCY TREATMENT AND I CANNOT BE CONTACTED *
SPECIAL EDUCATIONAL NEEDS
PLEASE GIVEN DETAILS OF ANY SPECIAL EDUCATIONAL NEEDS YOUR CHILD HAS:
NURSERY/PRE-SCHOOL
NURSERY/PRE-SCHOOL ATTENDED
RELIGION *
FIRST LANGUAGE
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 AT HOME:
TRAVEL TO SCHOOL ARRANGEMENTS
HOW WILL YOUR CHILD TRAVEL TO SCHOOL ON MOST DAYS *
LOCAL VISITS - I GIVE PERMISSION FOR MY CHILD TO LEAVE THE SCHOOL UNDER THE SUPERVISION OF A MEMBER OF STAFF TO UNDERTAKE LOCAL VISITS ON FOOT E.G. WALKING TO CHURCH OR THE LIBRARY ETC. FROM TIME TO TIME *
Required
DATA PROTECTION
I UNDERSTAND THAT THE DATA HELD BY THE SCHOOL ON MY CHILD IS KEPT IN ACCORDANCE WITH THE DATA PROTECTION ACT 2018.  NB A COPY OF THE PRIVACY NOTICE CAN BE FOUND ON THE SCHOOL WEBSITE. *
Required
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Wanstead Church School. Report Abuse
Google Forms