CHURCH DRIVE PRIMARY SCHOOL
 APPLICATION FOR FOUNDATION STAGE 1

Child’s
Surname:	

	Legal Surname:		
Forename:	
	Middle name:		
Chosen name:	
	Gender:		
Date of Birth:	
	
Address:		

	
Post Code:	
	
HomeTelephone:	
	
Email:	
	
School Use Only	Birth Certificate Seen   Yes/No

Name of child’s mother:

Date of Birth:	
Address

	
Tel. No.

Name of child’s father:

Date of Birth	
Address (if different)

	
Tel. No.

Please give details of all persons who have parental responsibility and anyone else you wish to be contacted in an emergency.    Place them in the order that you wish for them to be contacted in an emergency.

Priority	Name/Relationship	Home Address/Phone/Mobile/Fax	Work Address Phone/Email	
	, 	

Tel: 

Mobile: 	 
Tel: 

Email: 	

Tel: 

Mobile: 	
Tel: 

Email:

	

	

Tel: 

Mobile: 	
Tel: 

Email:	

		

Tel: 

Mobile: 	
Tel: 

Email:	

Travel Arrangements	

		Bicycle		Train		Car/Van		Walk		Taxi		School Bus		Car Share		

		London Underground		Public Bus Service		Metro/Train/Light Rail		Other		

FAMILY DETAILS
Name of children in family (oldest first)
	Date of birth	Name of school (if appropriate)	

			

			

We will try to accommodate your preference of morning, afternoon or full time sessions but the final decision must rest with the Headteacher.

Morning session ………………....

Afternoon session ……………….

30 hours free childcare (all day sessions) Limited places for parents who qualify………………

Medical Practice:
		
Address:

			
Telephone Number:

Does your child stay with a childminder?       YES / NO

Has your child any pre-nursery experiences?       YES / NO

Please state name and address (if applicable):

Playgroup…………………………………………………..   Creche …………………………………………………………………

Family Centre ……………………………………………..   Parent/toddler group ………………………………………………..

Name of health visitor (if known)  ……………………………………………………………………………

Name of social worker (if appropriate)

Medical Condition(s)

	

Medical Note(s)

	

Any additional information you think we should know:

	

Ethnicity :	
	
Home Language:	
	Religion:		
General Data Protection Regulations 2018:  The school is registered under GDPR for holding personal data. The school has a duty to protect this information and to keep it up to date. The school is required to share some of the data with the Local Authority and with the DfES.	
Signature:

	Date: