DATA COLLECTION SHEET

Please check that the information below is correct. 
Complete any missing details, and return to the school office.

Surname:		Legal Surname:		
Forename:		Middle name:		
Chosen name:		Gender:		
Date of Birth:		Year:		Reg Group:		
Address:			
Post Code:		
Telephone:		
Email:		

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	
1		 
Tel: 
Mobile: 	 
Tel: 
Email: 	
2		 
Tel: 
Mobile: 	
Tel: 
Email: 	

Travel Arrangements		
If the above information is incorrect, please tick the appropriate choice	
		Bicycle		Train		Car/Van		Walk		Taxi		School Bus		Car Share		
		London Underground		Public Bus Service		Metro/Train/Light Rail		Other		
	
Route		

Dietary Needs		
Dietary Preferences		
Meal Arrangement		 	
If the above information is incorrect, please tick the type of meal to have for each day of the week below.	
	Type of meal	Mon	Tue	Wed	Thu	Fri		
	School Meal								
	Packed Lunch							
	Home							

Medical Practice:		
Address:			
Tel:		

Medical Condition(s)	

Medical Note(s)	

Ethnicity :		
Home Language:		Religion:		

Data Protection Act 1998:  The school is registered under the Data Protection Act 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 DCSF.	
Signature:	Date: