Queensmead School - Student Information Form
All information is treated as confidential to the School
Child's details
Child's Surname
Your answer
Child's Forename
Your answer
Family Surname
Your answer
Boy/Girl
Date of Birth
MM
/
DD
/
YYYY
Child's Form Group at Queensmead
Your answer
House Number
Your answer
Road Name
Your answer
Town
Your answer
County
Your answer
Post Code
Your answer
Home Telephone Number
Your answer
Email Address of Parent
Your answer
Ethnicity *
Nationality *
Country of Birth *
Your answer
Home Language *
Your answer
Religion *
Your answer
We are required to record the names and addresses of every person who has parental responsibility for the child under the Children Act
Parent / Legal Guardian with whom the child lives
Name
Your answer
Relationship
Name
Your answer
Relationship
Other Parent / Legal Guardian
Name
Your answer
House Number
Your answer
Road Name
Your answer
Town
Your answer
County
Your answer
Post Code
Your answer
Telephone Number
Your answer
Relationship
Name
Your answer
House Number
Your answer
Road Name
Your answer
Town
Your answer
County
Your answer
Post Code
Your answer
Telephone Number
Your answer
Relationship
In case of emergency, please provide emergency telephone contact numbers
Mother - Daytime Telephone
Your answer
Mobile
Your answer
Father - Daytime Telephone
Your answer
Mobile
Your answer
Other Contact Name
For example: Grandparent
Your answer
Telephone
Your answer
Other Contact Name
For example: Grandparent
Your answer
Telephone
Your answer
Medical Information
Child's Doctor
Your answer
Number
Your answer
Road Name
Your answer
Town
Your answer
County
Your answer
Post Code
Your answer
Telephone
Your answer
Medical conditions that you feel we should be aware of
This will go on the Care & Attention list
Your answer
I do/do not wish the school to administer one paracetamol tablet for pain relief in routine circumstances
Asthma
Hayfever
Child's Previous School
Your answer
Lunch-time Arrangements
Please tick as appropriate
Travel Arrangements
Please tick usual arrangement
Armed Forces/Services Personnel
Please tick as appropriate
Language Option
Please tick as appropriate
Privacy Notice
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https://docs.google.com/document/d/1zvO-QDkBekW4pK3Cm-mU3vFRK1IFuLYj9t6L3zJ4NeE/edit

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