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UTC Student Information Form
Pupil data is essential for UTC Plymouth's operational use and to meet the school's legal obligations. Full details of what data and why we hold it is available via the website (
www.utcplymouth.org
)
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* Indicates required question
Email
*
Your email
PUPIL DETAILS
Legal Surname
*
Your answer
Legal Forename
*
Your answer
Date of Birth
*
MM
/
DD
/
YYYY
Gender
*
Female
Male
Prefer not to say
Other:
Preferred Name (either forename or surname)
Your answer
ADDRESS DETAILS
Number/Street
*
Your answer
Town
Your answer
Postcode
*
Your answer
PARENTS DETAILS
Guardian 1 - Surname
*
Your answer
Guardian 1 - Forename
*
Your answer
Guardian 1 - Address (if different to pupil)
*
Your answer
Guardian 1 - Home No.
*
Your answer
Guardian 1 - Mobile No.
*
Your answer
Guardian 1 - Email
*
Your answer
Guardian 1 - Relationship to Child
*
Your answer
Guardian 1 - Do you have parental responsibility?
*
Yes
No
Guardian 2 - Surname
*
Your answer
Guardian 2 - Forename
*
Your answer
Guardian 2 - Address (if different from pupil)
*
Your answer
Guardian 2 - Home No.
*
Your answer
Guardian 2 - Mobile No.
*
Your answer
Guardian 2 - Email
*
Your answer
Guardian 2 - Relationship to Child
*
Your answer
Guardian 2 - Do you have parental responsibility?
*
Yes
No
Is the child resident with a Foster Parent?
*
Yes
No
Is, or previously, was the child a Looked After Child?
*
Yes
No
If you have answered Yes to either question, please provide the details of any foster parents/carers.
*
Your answer
EMERGENCY CONTACTS (There should be at least two emergency contacts please)
Contact Priority 1 - Name
*
Your answer
Contact Priority 1 - Home No.
*
Your answer
Contact Priority 1 - Mobile No.
*
Your answer
Contact Priority 1 - Relationship to child
*
Your answer
Contact Priority 2 - Name
*
Your answer
Contact Priority 2 - Home No.
*
Your answer
Contact Priority 2 - Mobile No.
*
Your answer
Contact Priority 2 - Relationship to child
*
Your answer
MEDICAL INFORMATION
Doctors Name
Your answer
Surgery Address & Telephone No.
Your answer
Do you consent to your child being given first aid by a trained member of staff in the event of an accident or illness?
*
Yes
No
Do you consent to your child being given emergency hospital treatment in the event of an accident or illness?
*
Yes
No
Are any of the following applicable to your child - please tick.
Asthma
Eczema
Epilepsy
Arthritis
Diabetes
ADHA
Allergies
Other (please give details in the box below)
If you ticked Other above, please give details
Your answer
Does your child take regular medication? (please specify below)
Your answer
DIETARY NEEDS
Please specify dietary needs of your child below
Column 1
Vegetarian
No Beef
No Pork
Kosher Only
Gelatine Free
Halal
No Nuts
No Diary
No Seafood
Gluten Free
Other
Column 1
Vegetarian
No Beef
No Pork
Kosher Only
Gelatine Free
Halal
No Nuts
No Diary
No Seafood
Gluten Free
Other
Clear selection
Does your child have any allergies? (please specify below)
Your answer
SPECIAL EDUCATIONAL NEEDS INFORMATION
If your child has any Special Educational Needs (SEN) that we need to be aware of, please choose from the following:
SEN Categories (please choose applicable) If category isn't listed, please give details in the next box
Column 1
EHCP/EHAT
Behavioral and Social
Deaf
Speech, Language & Communications Difficulties
Visual Impairment
Behaviour, Emotional & Social Difficulties
Autism Spectrum Disorder
Hearing Impairment
Physical Disability
Multi-Sensory Impairment
Column 1
EHCP/EHAT
Behavioral and Social
Deaf
Speech, Language & Communications Difficulties
Visual Impairment
Behaviour, Emotional & Social Difficulties
Autism Spectrum Disorder
Hearing Impairment
Physical Disability
Multi-Sensory Impairment
Other Special Educational Need
Your answer
Is your child considered to be a Young Carer?
Yes
No
Clear selection
SCHOOL MEALS
Please indicate below whether your child will be bringing their own lunch, they are entitled to Free School Meals, etc
Meals
Entitled to Free School Meals (if you are in receipt of a benefit such as Income Support or Universal Credit. Evidence must be provided to support claim)
Has your child been entitled to FSM in the last six years?
Packed Lunch
Paid School Meal
Travel - Please indicate how your child will be travelling to school, you may choose more than one
Walk
Bus
Car
Taxi
Cycle
Train
ETHNICITY & NATIONALITY
Ethnicity
Your answer
Nationality
Your answer
Country of Birth
Your answer
Asylum Status
Choose
Child is seeking asylum
Child is a refugee
Religion
Your answer
Languages - Please indicate the languages spoken at home
Your answer
Submit
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