Student Admission Form

Contact Priority 1 (if parents/carers not available)

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Title

Surname

Forename

Relationship to student

Mobile telephone number

Home telephone number

Work telephone number

Contact Priority 2 (if parents/carers not available)

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Title

Surname

Forename

Relationship to student

Mobile telephone number

Home telephone number

Work telephone number

█ Family Information

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Please give details of any other children living at the same address:

Name (Child 1)

Date of Birth

School

Name (Child 2)

Date of Birth

School

Name (Child 3)

Date of Birth

School

Name (Child 4)

Date of Birth

School

█ Lunch Arrangements

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Lunch Choice (please tick relevant box)*: School Meal Free School Meal** Packed Lunch *Special Dietary requirements

* Please provide details

The Education Funding Agency are committed to ensuring that those students who claim Free School Meals receive additional funding for their education. For 2016/2017 educational establishments will receive an additional £935 per student, so please do check your eligibility and claim if you are entitled to. **Should you wish to check your eligibility for Free School Meals please use the following sources.

https://www.cambridgeshire.gov.uk/residents/children-and-families/schools-&-learning/help-with-school-&-learning-costs/ Ms Hayley Coppin, Finance Department, Email: Tel: +0044 (0)1223 712150 (Internal ex. 159)

Please supply any further information (religious or cultural - e.g., food, dress, days of observance) which you feel may impact on your child’s school life.

█ Medical Details

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It is important that you provide us with information of the medical centre/surgery that your child is registered with

Surgery Name and Address

Surgery Telephone Number

Student’s Medical Needs/Conditions:

Long term medical conditions

Short term medical conditions

Occasional medical conditions

Ongoing medical conditions

Please note that if your child has a long term, ongoing health need they will require an Individual Health Care Plan (IHCP). The school will be in contact to arrange a suitable time to complete an IHCP with you.

Nut allergy Select Long term short term occasional ongoing

Asthma Select Long term short term occasional ongoing

Eczema Select Long term short term occasional ongoing

Additional Medical Note(s)

Should your child suffer from any medical conditions that require them to take medication at school, this will kept in a locked cupboard in our first aid-room. You will need to provide us with the following:
• Medication to be in its correct packet/container – blister packs for tablets are not accepted
• Bottled medicine must be new and unopened, so we can monitor correct usage
• MUST have a dosage on the packet/bottle if an ‘Over the Counter medicine’
• MUST have a prescription label if a prescription only medicine, with a valid ‘from’ date, expiry date, dosage and student’s name on it. The label must be clear and not tampered with
• Written permission from the parent to administer the medication

Name of medication

Dosage and frequency to be taken

It is the responsibility of the parent/carer to update the school of any changes to their child’s medical needs.

█ Special Education Needs (SEN)

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Does your child have any Special Needs Provision Select Yes No

If YES, please indicate below to confirm if your child is identified on the SEN register at their current school and, if they have a Statement of Education:

My Child is on the SEN Register Select Yes No

Does your Child have a Statement of Education Select Yes No

█ Ethnic Information

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To help us and the local authority in monitoring equal opportunities you are asked to complete the following: Family’s Ethnic Origin. (Our ethnic background describes how we think of ourselves. This may be based on many things, including, for example, our skin colour, culture, ancestry or family history. Ethnic background is not the same as nationality or country of birth.)

Ethnicity* Select White – British White – Irish White - Traveller of Irish Heritage White - Gypsy/Roma White - Any other White background Mixed - White and Black Caribbean Mixed - White and Black African Mixed - White and Asian Mixed - Any other mixed background Asian or Asian British –Indian Asian or Asian British – Pakistani Asian or Asian British – Bangladeshi Any other Asian background (This includes African Asian Nepali Sinhalese Sri Lankan Tamil) Black or Black British – Caribbean Black or Black British – African Any other Black background Chinese Any other ethnic group (see below) Afghan Arab Egyptian Filipino Iranian Iraqi Japanese Korean Kurdish Latin American Lebanese Libyan Malay Mauritian Moroccan Polynesian Thai Vietnamese Yemeni I do not wish an ethnic background to be recorded

Nationality *

Country of Birth*

First language *

Other language(s

Religion*

If English is not your first language

Does your child currently receive any additional English language support* Select Yes No

Does your child require any additional English language support* Select Yes No

█ Travel Arrangements

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Linked to the Government's Travel to School Initiative, we are currently refining a school travel plan, which details how our students travel to and from school. We would be grateful if you could tell us what mode of transport your child normally uses. Where he/she uses more than one mode of travel for each journey to school, you should tell us the most frequently used and/or the longest element of the journey by distance.

Most used method of transport* Select Taxi Bicycle Walking Other Car Car Share Train

█ Details of last school attended (pior to Chesterton Community College)

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Name and telephone number of the school the student is currently attending (this should include overseas education if applicable). If your child is not currently attending a school please tell us the most recent school they attended:

Name of School*

Country*

On what date did your child start at their current / last school*

On what date did your child leave/due to leave their current / last school*

Reason for leaving*

If your child is not currently attending school, please tell us the date on which your child left their most recent school:

If your child is from overseas, have they ever attended an English School Select Yes No N/A

If you have answered ‘Yes’ to this question, please give the full name and address of this school

Service Children in School*

Schools are now required to indicate whether a child has parent(s)/guardian(s) currently serving in regular military units of any of the armed forces, and designated as Personnel Category 1 or 2. Please could you indicate if your child is a ‘service child in education’ by ticking one of the boxes below* Select No Yes I do not wish a service children indicator to be recorded

In Local Authority Care* Select Yes No

If Yes, Name of Care Authority

█ Declaration

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I certify that, to the best of my knowledge, the information on this form is correct

Digital Signature (Please type your name)*

Relationship to child*

Date*

█ Parental/Carer Consent Section

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We require permission from you for several things. Please fill in the permission tick boxes below. More information about each tick box can be found at www.chestertoncc.net in the Parental Permission Section. In an instance of an organizer needing to contact you whilst your child is participating in a school trip the contact details used will be those recorded on our College database - it is therefore essential that any changes to contact telephone numbers are notified to the College as quickly as possible. Likewise, any medical conditions which your child may develop over their time at the College should also be reported to us.

Throughout my child’s time at Chesterton, I give the following permissions for my child:

█ Local Visits

There are times in every school year when we accompany groups of students on local visits out of school. An Art visit to the museum, a History walk into Cambridge and a PE fixture off-site are examples of this kind of short visit. Local visits are an important part of your child’s education and they are organised carefully and thoroughly. I would like to ask you to agree to your child taking part in local visits by signing the permission requirement below.

█ Local Visits Permission

Do you give permission for your child to be accompanied on a local visit without advance notice on the basis described?* Select Yes No

Name of Parent / Carer giving permission *

Date*

We will of course inform you, and request your specific consent, for trips which are further afield, take place outside of normal College hours and/or require a parental contribution

Use of Photograph/Video/DVD images

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At Chesterton Community College we take the issues of child safety very seriously, and this includes the use of images of pupils.

Throughout my child’s time at Chesterton, permission is given for my child. • To be photographed and those images be used*: In Chesterton publications On the Chesterton website By the local press If you are happy for your child’s image to be used by the local press but would prefer her/his name not to appear alongside the image

Name of Parent / Carer giving permission *

Date*

█ PSHE Education

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PSHE is a core part of the curriculum taught to all students at Chesterton. For full details of our PSHE curriculum and policy, please see the school website.

█ Biometric Data

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Chesterton Community College operates a Cashfree catering service.
New students will be enrolled onto the system upon joining the College. The method of recognition which Chesterton has chosen is Fingertip Scanning. This is the latest in secure technology and unlike other biometric methods does not store any personal identity data on the system. The process is completely safe and secure. A digit of each student will be scanned and a unique number will be recorded and scrambled. This process takes a few seconds. They will then simply place their finger (again for a few seconds) on the reader when they come to pay for their purchases in the canteen. The reading is very accurate, more accurate than other methods we have investigated. Students whose parents/carers do not consent to the use of biometric data will still have a cashless catering account. The use of biometric identification is our preferred method of accessing student accounts; students for who this data is not held will have their accounts accessed manually, by till operators entering the student's name - operating accounts in this way means that transactions will take longer and also carries a higher risk of administrative error, whereby incorrect accounts could inadvertently be debited.

█ Biometric Data Permission

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Do you give permission for the College to use biometric data for your child, as described?* Select Yes No

Name of Parent / Carer giving permission *

Date*

█ Student ICT Acceptable Use Consent

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Agreement: I, as a student of Chesterton Community College, am signing below to show that I have read, understood and will try to abide by the rules set out in the Student Acceptable Use Policy. This document can be found on our website under Policies

Name*

Date*

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