School Information Sheet

The Ruth Gorse AcademySchool Information Sheet

This form is to be completed by the Parent/Carer only and returned to the School Office. Please make sure that you have completed all sections on the School Information Sheet.

Your Child’s Surname: Legal Surname:Year Group:

LEGAL SURNAME: If your child uses another surname it is important that we still know their legal surname as any external examinations have to be registered in their legal surname.

Forename: Middle Name(s):Chosen name: Gender (M/F):Date of Birth:

SIBLINGS: If there are brothers/sisters in the school, please give the full name & present form. Also, if there are younger siblings, please state their current primary school.

Name: Form: Primary School:Name: Form: Primary School:

HOME ADDRESS OF CHILD

House Number and Street:

Town: Postcode:Home Telephone Number:

Email Address:

Please give details of all persons who can be contacted in an emergency. The Ruth Gorse Academy requires 3 different emergency contacts in order to ensure we can contact you if your child is ill at school. The admission form clearly states the priority in which we will contact individuals (if you wish to give more than 3 emergency contacts please use a separate piece of paper). It is important that if any of the contact details change e.g. telephone, mobile number, address that you let the school office know immediately in case of any emergency.

Priority 1 = PRIMARY CARER (the person who lives with the child)Surname: Forename:Title: Gender (M/F):Address:

Post Code: D.O.B.:Home Tel No:: Work Tel No:Mobile Number: Title of Work

Place:Email:Contact Notes:

Relationship to Child: (Parent/Step Parent)

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School Information Sheet

Does the person named above have Legal Parental Responsibility for the child? Yes No

Priority 2: SECONDARY CARER Surname: Forename:Title: Gender (M/F):Address:

Post Code: D.O.B.:Home Tel No: Work Tel No: Contact Notes:

Email: Mobile Number:Relationship to Child: (Parent/Step Parent)Does the person named above have Legal Parental Responsibility for the child?

Yes No

Priority 3: OTHER CONTACT DETAILS

Surname: Forename:Title: Gender (M/F):Address:

Post Code: D.O.B.:Home Tel No: Work Tel No:Contact Notes:

Email: Mobile Number:Relationship to Child: (Parent/Step Parent)Does the person named above have Legal Parental Responsibility for the child? Yes No

TRAVEL ARRANGEMENTS TO AND FROM THE ACADEMYPlease tick appropriate box.

Car/Van Bus TaxiBicycle Walks Authority Arranged TransportCar Share Other

DINNER ARRANGEMENTSPlease tick appropriate box.

School Dinner Paid School Dinner Free Sandwiches OtherDoes the named child qualify for Free School meals? Yes NoSpecial Dietary Needse.g. Gluten Free / Nut Free

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School Information Sheet

ETHNICITY

Please tick the appropriate box.White British White Irish Traveller of Irish HeritageGypsy/Roma White/Black African White Eastern EuropeanWhite/Asian White/Black Caribbean White Western European Indian Black Caribbean Black AfricanBangladeshi Kashmiri Other Kashmiri PakistanOther Pakistan Other Asian ChineseAny Other Ethnic Group Any other Black Background Any Other Mixed BackgroundRefused

NATIONALITY

Please tick the appropriate box.United KingdomPakistanIndiaIrelandBangladesh

Refused

COUNTRY OF BIRTH

Please tick the appropriate box.United KingdomIreland

Refused

LANGUAGES USED AT HOMEWe need to know what is the main language spoken at home. We will endeavour to communicate with you in this language where possible.

First Language: English as a second language: Yes NoPlease select YES if English in not the main language spoken in the home.Please select NO if English is the main language or the only language spoken in the home.In what language do you wish to receive communication from school:Additional Language used at home: If so, please state which Language and at what level e.g. Polish / Fluent

Religion: Please state:

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School Information Sheet

EDUCATIONAL HISTORY (if applicable)

Previous School/Nursery Address Start Date Leaving Date

ACADEMY CLOSURE: PERMISSION

In the unlikely but occasional event of an emergency school closure (e.g. blizzard, burst water main) are you willing for your daughter/son to be sent home or to a friend’s / neighbour’s / relation’s home? Please sign below and tick the relevant box. It is very helpful if you can make arrangements for this but we will arrange supervision for students for whom suitable home arrangements are not possible. STUDENTS IN ALL YEAR GROUPS ARE REQUIRED TO REMAIN ON SITE AT LUNCHTIMES AND MAY NOT LEAVE THE PREMISES.

Name of Student:

I Do give permission for my child to be sent home or to (an address which I have arranged) in case of an emergency school closure.I Do Not give permission for my child to be sent home or to (an address which I have arranged) in case of an emergency school closure.

Please tick the relevant box above.

PHOTOGRAPHS

Name of Student:

I Do give permission for my child to have photographs taken at school and used for displays around the school, in school publications and on the academy website.

I Do Not give permission for my child to have photographs taken at school and used for displays around the school, in school publications and on the academy website.

Please tick the relevant box above.

HOME CIRCUMSTANCES AND SUPPORTPlease give details of any recent changes in home circumstances plus any further information which you think may be of benefit to the school; e.g. special home circumstances, contact with outside agencies such as Social Services, Health Services etc. You may also wish to contact your child’s Head of Year at the school, directly by phone or by letter.

Name of Social Worker (if applicable):

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School Information Sheet

Please provide us with a specimen of your signature for our records.

Parent Signatory Carer/Guardian Signatory

Date: Date:

MEDICAL INFORMATIONDoctor’s Name: Tel No:

Address of Practice:

Medical Conditions/Allergies (of which the school should be aware of):

Should you wish to speak to a member of staff regarding your child’s medical information, please tick the box below:

I wish to speak to a member of staff regarding my child’s medical information.

The Ruth Gorse Academy is committed to meeting the learning needs of all our students. To enable us to tailor our lessons to individual students' learning styles, monitor and track students' progress effectively and put additional support in place if appropriate please answer the following questions:

Do you consider your child to have a disability?

The Ruth Gorse Academy uses the definition of disability given in the Equality Act (2010): 'a physical or mental impairment that has a ‘substantial’ and ‘long-term’ negative effect on your ability to do normal daily activities.'

‘Substantial’ This is more than minor or trivial. For example, it takes much longer than it usually would to complete a daily task like getting dressed.

‘Long-term’ This means 12 months or more. For example, a breathing condition that develops as a result of a lung infection.

Name of Student: Year:

Yes [tick box]No [tick box]

If yes, please give details:

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School Information Sheet

Do you consider your child to have a learning difficulty?

The Ruth Gorse Academy uses the definition of a learning difficulty given in the SEND Code of Practice ( April 2014): 'a child who has significantly greater difficulty learning than the majority of children of the same age.'

Yes [tick box]No [tick box]

If yes, please give details:

SUPPORT, INTERVENTION AND ENRICHMENT

You may be aware that schools receive additional funding known as Pupil Premium for students who have been in receipt of free school meals at any point in the last six years. Schools also receive this funding for children who have been looked after continuously for more than six months, and children of service personnel. At The Ruth Gorse Academy we focus on three key areas: support, intervention and enrichment. In order to apply for this additional funding, we rely on families to inform us if their children meet these criteria. Could you please therefore complete the table below. All information received will be treated in strictest confidence but will help the academy to obtain the funding it requires from the Department for Education to operate effectively.

I confirm that my child meets the following criteria for the Pupil Premium: My child has been adopted from care;My child left care under a Special Guardianship Order (SGO);My child left care under a Residence Order (RO).The Parent/Carer is in the Military Forces.My child had been in receipt of Free School Meals during the last 6 years.

This form is to be completed by the Parent/Carer only and returned to the School Office. Please make sure that you have completed all sections on the School Information Sheet.

This form can also be returned on Transition Evening to your child’s form tutor or Head of Year.

The deadline for this form to be handed in is 27 June 2017.

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