Queensmead School - Student Information Form
All information is treated as confidential to the School
Child's details
Child's Surname
Child's Forename
Family Surname
Boy/Girl
Date of Birth
MM
/
DD
/
YYYY
Child's Form Group at Queensmead
House Number
Road Name
Town
County
Post Code
Home Telephone Number
Email Address of Parent
Ethnicity *
Nationality *
Country of Birth *
Home Language *
Religion *
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
Relationship
Name
Relationship
Other Parent / Legal Guardian
Name
House Number
Road Name
Town
County
Post Code
Telephone Number
Relationship
Name
House Number
Road Name
Town
County
Post Code
Telephone Number
Relationship
In case of emergency, please provide emergency telephone contact numbers
Mother - Daytime Telephone
Mobile
Father - Daytime Telephone
Mobile
Other Contact Name
For example: Grandparent
Telephone
Other Contact Name
For example: Grandparent
Telephone
Medical Information
Child's Doctor
Number
Road Name
Town
County
Post Code
Telephone
Medical conditions that you feel we should be aware of
This will go on the Care & Attention list
I do/do not wish the school to administer one paracetamol tablet for pain relief in routine circumstances
Asthma
Hayfever
Child's Previous School
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
Please click on the link below to see our Privacy Notice.

https://docs.google.com/document/d/1zvO-QDkBekW4pK3Cm-mU3vFRK1IFuLYj9t6L3zJ4NeE/edit
Submit
Never submit passwords through Google Forms.
This form was created inside of Queensmead School. Report Abuse