Child Information Form

Parents/Guardians must complete this form 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 School Administrator.

Basic Student Details

Address Details

Please list below all persons who have ‘Parental Responsibility’ (ONLY) and place them in the order that you wish them to be used in the event of an emergency. (If you require extra contacts please complete the rest of the form and then contact the school office)

PRIORITY 1

Address Details (if different to student)

PRIORITY 2

Address Details (if different to student)

Meal Arrangements

None
Gluten Free
Halal
Artificial Colouring Allergy
No Pork
Kosher Foods
Vegetarian
No Nuts of any Quantity or Type
No Seafood
No Dairy
Bicycle
Train
Bus
Walk
Car
Coach
Taxi
Other

Student Medical Practice Details

Medical Information. Please do not leave blank. If your child does not have any medical problems, please write NONE in the box

Child in Care

Special Education Needs

Your Family

Please note: - a copy of your child’s birth certificate and baptism certificate must be provided if they have not already been given to the school

White British
Irish
Traveller
Gypsy
Roma
Albania
Bosnian-Herzegovina
Croatian
Greek
Greek-Cypriot
Kosovan
Serbian and Montenegro
Turkish
Turkish-Cypriot
White Eastern European (Including Belarus Bulgarian Czech Republic Estonia Hungary Latvia Lithuania Macedonia Moldova Poland Romania Russia Slovak Slovenia and Ukraine)
White Western European (Including Austria Belgium Denmark Finland France Germany Holland Italy Luxembourg Malta Norway Portugal Spain Sweden and Switzerland)
White Other
White and Black Caribbean
White and Black African
White and Pakistani
White and Indian
White and any Other Asian Background
White and Black Caribbean
White and Black African
White and Pakistan
White and Indian
White and any Other Asian Background
Asian and any other Ethnic Group
Asian and Black
Asian and Chinese
Black and any other Ethnic Group
Black and Chinese
Chinese and any other Ethnic Group
White and any other Ethnic Group
White and Chinese
Other Mixed Background
Indian
Bangladeshi
Mirpuri Pakistani
Kashmiri Pakistani
Other Pakistani
African Asian (Including East and South African Asian)
Kashmiri Other (Kashmiri respondents not wishing to be classified under Asian Pakistani should use this category)
Black Caribbean
Black European
Black North American
Other Black
Black – Angolan
Black – Congolese
Black –Ghanaian
Black – Nigerian
Black– Sierra Leonian
Black – Somali
Black – Sudanese (Including Sudanese of Egyptian origin)
Other Black African – (Including Black South African Angolan Zimbabwean Ethiopian Rwandan and Ugandan)
Chinese
Hong Kong Chinese
Malaysian Chinese
Singaporean Chinese
Taiwanese
Other Chinese
Afghan
Arab other – (Including Palestinian Kuwaiti Jordanian and Saudi Arabian)
Egyptian
Filipino
Iranian
Iraqi
Japanese
Korean
Kurdish – (Include Kurdish pupils from Iraq Iran and Turkey)
Latin/South/Central America – (including Belize and Cuba)
Lebanese
Libyan
Malyan – (Including Malaysian other than Malaysian Chinese)
Moroccan
Other Ethnic Group
Polynesian – (Including Fijian Tongan Samoan and Tahitian)
Thai
Vietnamese
Yemeni
I do not wish an ethnic background category to be recorded

I confirm the information submitted is correct

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