Enrolment Form

The form must be completed for all children (who have been offered a place) prior to entry into the school. It is essential all questions are completed fully. If you are unsure of anything, please speak to a member of the office team. Please note all information will be treated as confidential in accordance with GDPR regulations.

BEFORE YOU BEGIN, PLEASE READ!

Please allow 15-20 minutes to complete the form.

Once completed, you will be able to print the enrolment form. Unfortunately, it is impossible to save this form and come back to it later. For this reason, please have the following information to hand before you begin:

2 Prime contacts' information, address, telephone numbers2 Local emergency contacts' information, address, telephone numbersMedical practice address and telephone numberYour child's previous school name, telephone numberSchool Meals: Please read the parent handbook section and look at the school meal menu on websiteInformation on medical conditions & medicine

A - YOUR CHILD

Surname* Forename* Middle Name(s)

Select one of the following*MaleFemale

Date of Birth* Home Address* Town* Post Code*

Siblings at Amherst

Please name any siblings currently attending Amherst

	Name	Surname	Class

B - CONTACT INFORMATION

	Contact Number 1 - this person below will be the first person to be contacted in case of an emergency	Contact Number 2 - this person below will be the second person to be contacted in case of an emergency
Title: Mr/Mrs/Miss/Ms
Forename:
Surname:
Relationship to the child:
Address - if different from the child's home address:
Post Code:
Home Telephone number:
Work Telephone number:
Mobile number:
Email Address:
I agree to receive communication via the Schoolcomms secure platform used to communicate with parents: YES / NO

C - LOCAL EMERGENCY CONTACTS

	Contact Number 3 - The person below will be the third person to be contacted in case of emergency.	Contact Number 4 - (OPTIONAL) The person below will be the fourth person to be contacted in case of emergency.
Title: Mr/Mrs/Miss/Ms
Forename:
Surname:
Relationship to the child:
Home Address:
Town:
Post Code:
Home Telephone Number:
Work Telephone Number:
Mobile Number:
Email address:

D - EDUCATION & SPECIAL NEEDS

	School	Telephone Number
Which school did your child last attend?

Does your child have any Speech & Language difficulties?*YesNo

Does your child have any Special Educational Needs?*YesNo

If yes, what stage is your child at?

SEN Support*YesNo

EHC Plan*YesNo

A child in Public Care (Looked after Child) means a person under the age of 18 years for whom the Local Authority provided accommodation by agreement with their parents/carers or who is the subject of care order under Part IV of the Children’s Act 1989. Children who are looked after under an agreement series of short term placements such as respite are excluded.

Is your child adopted, or subject to a residence or special guardianship order, having previously been in public care? (Please tick the box if yes and send a copy of the adoption order to the school office.)

If a child’s parents are divorced, separated or there is a court order in place, can you please inform the school in writing of where your daughter/son lives during the school week and supply a copy of the court order arrangements. (Please tick the box if a letter will be sent to the office)

E - DIETARY INFORMATION

Please read all the information on School Meals provided in the Parent Handbook before answering this question.

Also have a look at the School Meal Menu on the Amherst School Website under PARENTS.

Please select the days on which your child’s would like to have a school lunch:

	Monday

	Tuesday

	Wednesday

	Thursday

	Friday

Dietary Requirements / Any Allergies e.g. Gluten Free, Vegetarian, Etc. Specific Religious Dietary Requirements

F - MEDICAL INFORMATION

The school has a medical room where children can be treated by a First Aider if they become unwell in school.First Aiders in school all hold current First Aid Qualifications and can provide care for children with a minor injury.Arrangements will be made directly with parents (or nominated emergency contact) for children who are clearly unwell, to be collected from school.Whilst we fully encourage 100% attendance, please do not send your child into school if they are obviously unwell, have a fever or suffered from sickness.You must advise us via the school website by going to Parents>Absence From School>Daily/Future Absence Form of the nature of the illness on the first day of absence and every day thereafter.

MEDICAL SURGERY INFORMATION


Surgery Name:
Surgery Address:
Town:
Post Code:
Telephone Number:

Please give details of any known medical conditions including allergies in the box below.
Please also give details of any mental health diagnoses.

* Please note all children with known medical conditions are required to have a “HEALTH CARE PLAN”
This must be completed on the school website under Parents>Health & Medication >Health Care Plan
* Health Care Plans for asthma are only required if the pupil is on medication.

Please give details of any medication taken on a regular basis:

Will your child require medication at school?*YesNo

Our medical policy allows us to administer medicine prescribed by your child's doctor. We are not able to administer over the counter medication.

An ADMINISTRATION OF MEDICATION FORM will need to be completed for any medicines held in school. This must be completed on the school website under Parents>Health & Medication >Administration of Medication Form. All medication will be held in the office and administered at an agreed time.

G - EMERGENCY CONSENT

Occasionally it is not possible to contact a parent when a child requires hospital treatment during school hours. In such cases, it will be necessary for a member of staff to accompany the child to hospital. The school will continue to try and contact a parent.

In the event of my child requiring emergency medical treatment and the Headteacher (or his representative) being unable to contact me, I give consent for the member of staff accompanying my child to approve the application of any emergency treatment including anaesthetic advised by the medical authorities for the wellbeing of my child.

Please give your consent:*Consent Given

	Name	Date

H - PHOTOGRAPHIC IMAGES CONSENT

Under GDPR regulations, it is important that we are open with you about the way that the school uses photographic and video records of students and seeks your consent to do so. Therefore, we would like to request your permission to use images taken in the ways detailed below:

The school will contact you should they need to use a photograph or video in any way that falls outside of the descriptions below.

I GIVE PERMISSION for the use of photographs and videos in:

- School displays (printed & digital) - School Newsletters - School Website - Videos - Parent Teacher Association - Including External Newspapers / Press*YesNo

	Name	Date

I - EDUCATIONAL VISITS / TRIPS

• Please give parental consent for local off-site activities offered by the school – These activities are part of the school’s curriculum and usually take place during the normal school day.

• Parental consent will be required for all other trips / educational visits.

• Please tick each button below:

*Chipstead Common for Cross Country Running

*Walking to St Mary's Church

*Riverhead Village and Parkland - local study of our town

*Chipstead Lawn & Tennis Club

*Walking to Bessels Green and Chipstead

Please give your consent:*Consent given

	Name	Date

J - MODE OF TRANSPORT TO GET FROM HOME TO SCHOOL

K - SCHOOLCOMMS / SCHOOLGATEWAY Communication

The school sends information, a weekly parent newsletter and other communication via email whenever possible. This information will be sent via Schoolcomms.
Please make sure to say YES in the SCHOOLCOMMS box (section B) for everyone wishing to receive communications in this way.

L - DATA COLLECTION

At times, we are required to provide the Department for Education with various statistical data.
We would therefore be grateful if you could supply the following information.
Please select one choice from the relevant categories below when completing this section.
Please note that any missing information will be marked a refused.

	Yes	No
Is English the first language of your child? (this will be the only language your child has been brought up in and hears and speaks at home)
If NO, what is the name of the first language your child has been brought up in?
Has your child grown up hearing and speaking more than one language at home?
If YES, please write the name(s) of these other languages:

L - ETHNIC ORIGIN

Our ethnic background describes how we think of ourselves. This may be based on many things, including, for example, our skin colour, language, culture, ancestry or family history. Ethnic background is not the same as nationality or country of birth.

Please study the list below and tick one box only to indicate the ethnic background of the pupils or child named above.

I hereby confirm that all the information given in sections A – L is true and correct to my knowledge.

This information was provided by:*ParentPupil

	Name of Parent / Guardian	Date

Personal email address if you would like to receive a copy of this form:

Please be reminded to send the following to the school office at office@amherst.kent.sch.uk:
- Proof of adoption
- Letter in case of divorce / separation, informing us of living arrangements of the child

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