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North Carlisle Childcare - Pupil information and Consent
Please can you provide the information below as we do not have access to each schools IT systems.
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Email
*
Your email
Name of Child
*
Your answer
Date of Birth
*
MM
/
DD
/
YYYY
My child normally attends the following school:
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Blackford CE School
Houghton CE School
Kingmoor Nursery and Infant School
Kingmoor Junior School
Rockcliffe CE School
Stanwix School
Other
Current National Curriculum Year Group
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Foundation (Reception)
Year 1
Year 2
Year 3
Year 4
Year 5
Year 6
Medical Questions
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Yes
No
Is your child asthmatic?
Is your child diabetic?
Is your child epileptic?
My child has a nut allergy?
Yes
No
Is your child asthmatic?
Is your child diabetic?
Is your child epileptic?
My child has a nut allergy?
Can you please list any allergies or other medical needs here. If none please enter "None"
*
Your answer
Emergency Contact Details
Please can you complete the following so that we can contact you in an emergency.
Name of Parent/Carer (1)
*
Your answer
Parent/Carer (1) Contact Phone Number
*
Your answer
Parent/Carer (1) Contact email
*
Your answer
Name of Parent/Carer (2)
Your answer
Parent/Carer (2) Contact Phone Number
Your answer
Parent/Carer (2) Contact email
Your answer
As part of the work of the the North Carlisle Childcare Hub it may be necessary for us to share information about your child with other professionals so that they can help us to provide the Keyworker Childcare service that your family need. We will treat your information as confidential and we will not share it with any other organisation unless we are required by law to share it or unless you will come to some harm if we do not share it. In any case we will only ever share the minimum information we need to share. I understand that the information that is recorded on this form will be stored and used for the purpose of providing services to:
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Yes
No
I consent to information being shared as necessary between my child's school, North Carlisle Childcare Hub and Cumbria County Council when appropriate.
Yes
No
I consent to information being shared as necessary between my child's school, North Carlisle Childcare Hub and Cumbria County Council when appropriate.
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