S11/1 Data Collection on Admission to School: Pupil Information and S11/2 Data collection on admission to Pre-School: contacts information
This form is for completion by the Parent/Carer of every child for them to apply for a place at the Pre-School.
Parents/Carers must also complete S11/2 giving your contact details as well as information on people to be contacted in the event of an emergency.
Please provide as much of the following information as you can. If you need help in completing the form, please ask the Pre-School Manager.

What we (the Pre-School) does with the information you have provided on this form There is information regarding the school's GDPR Policy here: https://www.southmead.devon.sch.uk/gdpr/

Please see weblink below for Department for Education privacy notice template and data protection toolkit:
Data protection: privacy notice model documents - GOV.UK (www.gov.uk): https://www.gov.uk/government/publications/data-protection-and-privacy-privacy-notices
Data protection in schools - Guidance - GOV.UK (www.gov.uk): https://www.gov.uk/guidance/data-protection-in-schools
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1. Pupil's basic details
Preferred forename (if different)
Middle Name(s)
Preferred surname (if different)
Gender *
Date of Birth *
MM
/
DD
/
YYYY
2. Pupil's address
Address *
Registering Session Interest - We are open between the hours of 9am until 3pm, 9am until 12 or 12 until 3pm. We open for 38 weeks of the year. Term time only.
 
Please can you state below the preferred days and hours you hope to receive. There is a minimum 6 hours attendance required. E.g. one full day or 2 half day sessions).
9am - 3pm
9am - 12 noon
12 noon - 3pm
Monday
Tuesday
Wednesday
Thursday
Friday
Please provide an original or photocopy of your child's birth certificate to prove their age.
I will provide a copy of my Two Year funding award letter if applicable.  My Golden Ticket number is:

Extended 15 hours (30 hours) entitlement.

Please note you must re - confirm your code every 3 months to continue to qualify. Cut off dates for codes are the 31st March, 31st August and 31st December. Pre-School must have the eligibility code the term BEFORE you want to use them.  

My extended 15 hours (30 hours) entitlement number is:

If your child attends another setting please state which one:

Are you claiming any funding there? If so, how many hours?

Please note, if you will you be claiming any funding here you are required to give 4 weeks’ notice to your previous setting or you will be invoiced for those weeks by us. Likewise, we require 4 weeks’ notice when you wish to leave our Pre-School.

3. Pupil's medical details
Emergency consent? e.g. the school has permission to give/arrange emergency treatment
 *
Dietary needs: please tick any that apply
Clear selection
Any other dietary needs not listed in previous question
Medical practice
Doctor’s name
 *
Surgery Name
 *
Surgery Address
 *
Surgery Phone Number
 *
Other medical information e.g.  asthma, diabetes
Ethnicity / religion / first language / nationality details

Our ethnic background describes how we think of ourselves.  This may be based on many things, including, for example, our skin colour, language, culture and ancestry or family history. Ethnic background is not the same as nationality or country of birth. The Information Commissioner recommends that young people aged 11 years old or above have the opportunity to decide their own ethnic identity. Parents, or those with parental responsibility, are asked to support or advise those children aged over 11 in making this decision wherever necessary. 

Ethnic information was provided by:
 *
Please tick one box only *
Religious affiliation: please tick one box only
*
Required
Other Religious Affiliation
Pupil's first language - What was the first language your child understood/spoke?  The Department for Education advise that this information will help them understand a range of factors, allowing them to better plan to meet needs within the school system.
 *
Other language
Asylum status (please tick if either of the following apply)
Additional details
Mode of travel -  Please tick to indicate which of the following your child is most likely to use to get to school: *
Route (if known)
Service Child - Does this child have a parent(s) in regular HM Forces military units? (applies to children whose parents are Pstat Cat1 or Pstat Cat2)

For further information please see 'MOD personnel categories definition' in the Additional Guidance section of our website at https://new.devon.gov.uk/supportforschools/administration/school-census

 *
Recoupment - The following information is required so that the Local Authority can recover the cost of educating children who are not its responsibility, mainly because the child's normal place of residence falls within a different Local Authority.
Please tick the appropriate box if you pay Council tax to one of the following Councils:
Clear selection
Linked Agencies - It is important that all the agencies who are working with a child work together to ensure better outcomes for that child. In order to do that, please identify any other agencies working with your child, for example Social Care (i.e. Social Services)*, Youth Offending Team, Child and Adolescent Mental Health Services. Please list any agencies below:

*  If you indicated above that Social Care (Social Services) are involved in the care of your child, please tick if this child is 'In Care' (sometimes known as being 'Looked After') and state which Local Government Authority is responsible for this child, e.g. Devon, Torbay etc below.
Please list any agencies below:
If a child in care - please confirm Local Authority responsible for child
Special Educational Needs
Previous Pre-School -  Please provide details of the last school attended (includes Nursery Schools/Units or Pre-Schools/Playgroups)

School Name
Pre-School Address (if known)
Pre-School tel. no. (if known)
Date of arrival at previous Pre-School - *an approximate date would be helpful if the exact date is not known e.g. September 2017
MM
/
DD
/
YYYY
Date of leaving previous Pre-School - *an approximate date would be helpful if the exact date is not known e.g. September 2017
MM
/
DD
/
YYYY
Reason for leaving, e.g. moved house
Siblings please give details of any other children in your family with their dates of birth.
Parent Signature - By submitting this form you are agreeing to the time stamp (date and time of submission) as the date of your signature of the form
 *
Required
I give my permission for information to be shared between Southmead Pre-School and the other childcare settings my child attends, including my child’s future School as part of their regular transition process. This encourages a smooth and settled next step as part of their learning journey. 
 *
Required
What the Local Authority does with some of the information in this form
Devon County Council uses information about children and young people to enable it to carry out specific functions for which it is responsible. The Council also uses this personal data to derive statistics which inform decisions it makes (e.g.) regarding the funding of schools, assess their performance and to set targets for them. These statistics are used in such a way that individual children cannot be identified.

Further information on how the Local Authority uses your data is available in "What the LA does with your data" guide https://new.devon.gov.uk/supportforschools/administration/information-governance/privacy-notices
Contacts Information
Please give details of everyone who has parental responsibility ** and anyone else to be contacted in an emergency. Please give details of parents/guardians first, but give a low number in the “contact priority” box for any other people who should be contacted in an emergency. (Contact priority 1, i.e. the first person to contact  in an emergency, contact priority 2, ie the second person to contact in an emergency, etc).

** What is parental responsibility? Parental responsibility means assuming all the rights, duties, powers, responsibilities and authority that a parent of a child has by law. A person with parental responsibility for a child has the right to make important decisions about their upbringing, for example,

  • Decisions about where they live
  • Whether the child should receive medical treatment
  • What religion they should follow
  • Which school they should attend
Who has parental responsibility? Mothers and married fathers automatically have parental responsibility and will not lose it if they later get divorced. Unmarried fathers do not automatically have parental responsibility. An unmarried father can get parental responsibility by:
  • Registering the birth jointly with the mother (born from 1st Dec 2003)
  • Through a 'parental responsibility agreement' between him and the child's mother
  • As the result of a court order
People other than a child's natural parents can acquire parental responsibility through
  • Being granted a residence order or a child arrangement order (from 2014)
  • Being appointed a guardian
  • Being named in an emergency protection order (although parental responsibility in such a case is limited to taking reasonable steps to safeguard or promote the child's welfare)
  • Adopting a child
In addition, a local Authority can acquire parental responsibility if it is named in the care order for the child.

For further information please see https://www.gov.uk/parental-rights-responsibilities/who-has-parental-responsibility.

We cannot refuse to release your child into the care of an adult who has proved that they have Parental responsibility unless we have the required legal paperwork which prevents it.

If we have not met the person with Parental responsibility before, our Staff will follow the Unknown Person Collection Policy.  Your child will not be released from our care.

Our staff will not release your child to anyone else other than those names below unless they have received written or verbal permission to do so.  If they are unable to contact you they will follow our Collections Procedure.

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