Admission Form 2020/2021
Please fill all boxes as accurately and completely as possible.
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Student Details
Legal Surname *
Legal Forename *
Chosen Surname *
Chosen Forename *
Middle Name(s) *
Date of Birth *
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/
DD
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YYYY
Gender *
Address *
Post Code *
Mobile Number *
Home Number
Parent/s email address *
Ethnic Origin/Please see attached sheet *Language spoken at home *
Religion *
All Previous Schools Attended
Please include name of school, town, date admitted and date left
Previous Schools *
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
Contact 2 *
Please include name, relation to student, day time address and daytime phone number or mobile
Contact 3
Please include name, relation to student, day time address and daytime phone number or mobile
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.
Parent details - Contact 2
Please include name, relationship to student, address, occupation and place of work and telephone number or mobile for text alerts.
Parent/Parents ever served full time in the Armed Forces? *
Pupil Nationality *
Pupil Country of Birth *
Medical Details
Name of Doctor *
Name of Surgery *
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.
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)
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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