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Online Enrolment Form

The Pingle Academy - Student Enrolment Form

The information which you enter on this form is required for the efficient organisation of the school and the children’s educational needs. It will be kept on the office computer under restricted access and is subject to the provisions of the Data Protection Act. The information will be disclosed only to the Education Authority, the health and welfare agencies, or where a law or an emergency necessitates a disclosure. The information held must be kept up-to-date by law and so if any of the information which you now supply changes in the future, will you please notify the school in writing or update via the Parent SIMS app.

NOTE: IF YOU ARE UNSURE OF A QUESTION PLEASE PRESS (?)

Section 1: Student Personal Information

Gender*

BEFORE COMPLETING THIS SECTION PLEASE REFER TO THE NOTES AT THE END OF THIS FORM RELATING TO 'PARENTAL RESPONSIBILITY'

Section 2: Parents/Carers

Parent/Carer 1

Title*
Relationship to Student*
Do you have parental responsibility?*
Are you in the Armed Forces?*

Parent/Carer 2

Title
Relationship to Student
Do you have parental responsibility?
Are you in the armed forces?

Emergency Contact Details

DETAIL BELOW A MAXIMUM OF FOUR CONTACTS, WHICH SHOULD INCLUDE PARENTS/GUARDIANS DETAILED ON PAGE 1, WHO MAY BE CONTACTED IN THE EVENT OF AN EMERGENCY.

First Contact (Default Emergency Contact)

Relationship to Student*

Second Contact

Relationship to Student*

Third Contact

Relationship to Student

Forth Contact

Relationship to Student

Medical Details

Permission to contact Doctor/other professionals involved with your child?*

Other Details

TRAVEL ARRANGEMENTS: Please select the USUAL mode of transport*
LUNCH ARRANGEMENTS: please select the USUAL arrangements for lunch.*
DIETARY NEEDS: does your child have any dietary needs?*
If 'Yes' please select from the following

CULTURAL INFORMATION

First Language*

FIRST LANGUAGE: is the language which your child was first exposed to during their early development and continues to use this language in the home or in the community.

ETHNICITY: 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.

HOME LANGUAGE: is the language which your child speaks at home.

RELIGION: if chosen religion is not listed, please select unclassified.

ETHNICITY*
Home Language*
Religion*
Is English an additional language for your child?*

School History

Does your child have a statement of SPECIAL EDUCATIONAL NEEDS?*
Has your child been assessed as DISABLED?*
Is your child "looked after" by a local authority (Sometimes referred to as "BEING IN CARE")*
Do you consider your child to be a YOUNG CARER?*

Siblings

If there is an older brother or sister currently attending The Pingle Academy, please detail below.

PARENTAL RESPONSIBILITY – GUIDANCE NOTES

Parental responsibility is a shared duty throughout a child’s life. If the parents separate or divorce, that responsibility does not disappear nor is it reallocated to one parent rather than the other. It continues to be shared. It is lost only in adoption.

Parental responsibility is defined in the Children Act 1989 as assuming all the rights, duties, powers, responsibilities and authority that a parent of a child has by law. If the parents of a child were not married to each other when the child was born, the mother automatically has parental responsibility but the father does not, even if he is named on the birth certificate.

NB: If the child’s birth is registered or re-registered on or after 1 December 2003 and the father is named on the birth certificate of a birth registered or re-registered after that date he will gain parental responsibility even if the parents were not married at the date of the child’s birth. It is not possible for a birth to be re-registered so that the father can acquire parental responsibility if the father has already been correctly registered on the birth certificate at the time the child was born, but the parents were not married at that time. However, in the case of children born after November 2003 and due to start school in September 2008 if a father’s name appears on the birth certificate, and the birth was registered on or after 1 December 2003 he will have parental responsibility.

Unmarried fathers can gain parental responsibility by various legal means. They can be formally granted parental responsibility by the child’s mother, (this has to be registered with a court), by being granted a residence order in respect of the child and by adopting the child. People other than the child’s natural parents can also acquire parental responsibility through being granted a residence order, being appointed as a guardian for the child, adopting the child and by being named in a Care Order or Emergency Protection Order (although in these circumstances parental responsibility is limited to taking reasonable steps to safeguard or promote the child’s welfare and would not extend to changing the child’s name).

PARENTAL CONSENT

FOR A ROLLING PROGRAMME OR SERIES OF LOCAL VISITS

I understand that my child may leave the school premises for local, regular or routine visits and hereby consent for my child to participate in such visits. I also understand that my child may leave the school premises at other times when I will be informed separately by letter as additional consent may be required from me. I undertake to inform the academy of any change in the medical or other circumstances as soon as possible after the date below. If the school is unable to contact me, I authorise the adults in charge to consent to any medical treatment for my child which a qualified medical practitioner deems necessary.

Photograph Use Consent

I GIVE CONSENT FOR THE PINGLE ACADEMY TO USE PHOTOS OR VIDEOS OF MY CHILD........

1. Around the Academy*
2. On Academy Visits*
3. In Academy & external publications*
4. In Academy newsletters*
5. In our Academy prospectus*
6. On our website, press or Academy social media*

Please note that when you provide consent, we will keep it on file over the course of your child's time at school. If anything changes, please let us know.

Signature of Parent/Guardian

SIGNATURE: I AGREE THAT THIS ELECTRONIC SIGNATURE IS THE LEGAL EQUIVALENT OF MY MANUAL SIGNATURE*
By ticking this box I confirm all the above details are correct to the best of my knowledge*
The Youth Support Service has legal access to name and address for student and parent for careers and support purposes. Please tick this box to consent to sharing other information in this form.*