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Student Information Form

Privacy Notice

Please click here for our Privacy Notice - this details how we will use the information that you provide below.

Student Details

Student Legal Forename:(Required)

Student Middle Name(s):(Required)

Student Legal Surname:(Required)

Student Preferred Name (if different):

Student Date of Birth(Required)

Gender(Required)

House / Flat Number:(Required)

Address:(Required)

Postcode (include a space):(Required)

Siblings at Pinner High School

Is there a brother / sister already at Pinner High School?:(Required)

If yes, please give the names and forms:

Parent / Legal Guardian Details with whom the child lives

The details given here should be of the Parent/Guardian with the same address as the Student

Title(Required)

Name(Required)

First Last

Relationship to student:(Required)

Parental Responsibility:(Required)

Mobile Phone Number:(Required)

Home Phone Number:(Required)

Work Phone Number:(Required)

Email Address:(Required)

Other Parent / Legal Guardian

Title(Required)

Name(Required)

First Last

Relationship to student:(Required)

Parental Responsibility:(Required)

Mobile Phone Number:(Required)

Home Phone Number:(Required)

Work Phone Number:(Required)

Email Address:(Required)

House / Flat Number:(Required)

Address:(Required)

Postcode:(Required)

Additional Contact

Title:(Required)

Name(Required)

First Last

Relationship to student:(Required)

Phone Number:(Required)

Student Medical Information

The school staff needs to be fully informed about any medical condition which may require attention in school.

Name of Medical Practice:(Required)

Address of Medical Practice:(Required)

Postcode of Medical Practice:(Required)

Medical Practice Contact Number:(Required)

Medical Conditions

Does your child have Asthma?:(Required)

Asthma Treatment Details: (if yes to previous question)

Does your child have Diabetes?:(Required)

Diabetes Treatment Details: (if yes to previous question)

Does your child have Epilepsy?:(Required)

Epilepsy Treatment Details: (if yes to previous question)

Does your child have any known Drug Allergies?:(Required)

Details of Drug Allergies: (if yes to previous question)

Does your child have any Other Allergies?:(Required)

(If your child is likely to suffer from an allergic reaction, it is the parent’/carer’s responsibility to ensure that your child carries their epipen at all times.)

Please list the allergies and any treatment details: (if yes to previous question)

Does your child have a Heart Condition?:(Required)

Heart condition details: (if yes to previous question)

Does your child suffer from Fits, Fainting or Blackouts?:(Required)

Details on Fits, Fainting and Blackouts: (if yes to previous question)

Does your child suffer from Severe Headaches or Migraines?:(Required)

Details on Severe Headaches and Migraines: (if yes to previous question)

Does your child suffer from Travel Sickness?:(Required)

Details on Travel Sickness: (if yes to previous question)

Does your child suffer from Back, Knee or Other Joint Problems?:(Required)

Details on Back, Knee or Other Joint Problems: (if yes to previous question)

Are there any other medical conditions the school needs to be aware of?:(Required)

Please give details below: (if yes to previous question)

Medication

If your child requires medication prescribed by a doctor, please request a Medication Consent Form from the school, which should be completed by a person with parental responsibility and returned to the school with the said medication in its original packaging.

Has your child received a vaccination against Tetanus in the last five years?:(Required)

Is your child receiving any medical or surgical treatment from their doctor or hospital?:(Required)

Has your child been given specific medical advice to follow in an emergency?:(Required)

If yes to either of the last two questions, please give details here (include any dosage of medicines/tablets):

In the case of serious injury that requires immediate medical attention an ambulance will be called, and parents contacted.

This section below is optional. If you would prefer not to provide the information, please select the Refused option.

Ethnicity

Which ethnic origin best describes your child?:

Religion

Religion (if any) of child (Please select Refused if you do not want this to be recorded):

English as an Additional Language

1st language is any language other than English that your child was exposed to during early development and continues to be exposed to, irrespective of your child’s proficiency in English.

Is a language other than English used at home:(Required)

If yes, which is the first language?:

Second language?:

Pupil Premium

This is a grant provided to the school by the government to support your child through their education. We can receive a pupil premium grant in respect of your child if any of the following circumstances are met (use the link below to apply):

Applications can be made via www.harrow.gov.uk/freeschoolmeals. The school will only be able to see your contact details, the date you applied and whether or not you are eligible. None of your personal or financial information is passed onto the school.

Free School Meal Eligibility Information

Free School Meals are available to any full-time student who is still at school and eligible. You can get Free School Meals for your child if you or your partner gets either:
• Universal Credit with an annual net earned income of no more than £7,400.
• Income Support.
• Income-based Jobseeker's Allowance
• Income-related Employment and Support Allowance
• Support under Part 6 of the Immigration and Asylum Act 1999
• The Guarantee element of Pension Credit
• Child Tax Credit, provided they are not entitled to Working Tax Credit and have an annual income of £16,190 or less
• Working Tax Credit run-on – paid for four weeks after you stop qualifying for Working Tax Credit

From 1 April 2018, all existing free school meals claimants will continue to receive free school meals whilst Universal Credit is rolled out. This will apply even if their earnings rise above the new threshold during that time.

Applications can be made via www.harrow.gov.uk/freeschoolmeals . The school will only be able to see your contact details, the date you applied and whether or not you are eligible. None of your personal or financial information is passed onto the school.

If eligible for free school meals, the school will be provided with extra money from the government for school meals and to support your child through their education.

Meals

Please select your child's meal pattern:(Required)

Mode of Travel to School(Required)

Special Educational Needs

Was your child identified at Primary School as having special educational needs?:(Required)

If yes, what are your child’s needs?:

Does your child have input from external agencies such as CAMHS, Speech and Language Therapy, Occupational Therapy?:(Required)

Contact Details of Agency:

Does your child have an Education, Health and Care Plan?:(Required)

School History

Name of Current School:(Required)

Start Date at Current School:(Required)

Date Leaving Current School:(Required)

Consents

If you change your mind about any of the below consents at a later date, please inform the school office.

Photographic Consent

Are you happy for your child's image to be used in print and or web based school publicity materials to showcase the school's activities (e.g. internal displays, school website and social media accounts, school prospectus and other media publicity)?(Required)

Educational Visit Consent

The following consent allows your child to:

a) To take part in school visits and other activities that take place off school premises during their time at Pinner High School.

b) To be given first aid or urgent medical treatment required during any school visit or activity.

Please note the following important information:
The visits and activities covered by this consent include:
• day visits that take place wholly or mainly within the normal school day
• offsite sporting fixtures

The visits and activities not covered by this consent include:
• educational visits that take place wholly outside of the normal school day
• educational visits requiring one or more overnight stay
• educational visits involving adventurous activities

The school will send you information about each visit or activity before it takes place.

When we inform you of a visit you can, if you wish, tell the school that you do not want your child to take part in that particular school visit or activity, unless it is part of the national curriculum.

Are you happy for your child to take part in school visits and other activities as described above that take place off school premises during their time at Pinner High School?(Required)

Medical Consents

Do you authorise the school to administer PARACETAMOL as they consider necessary or your child’s own branded equivalent medicine(s) according to medical instructions.(Required)

If your child suffers from asthma, it is the parent’s /carer’s responsibility to ensure that your child carries their inhaler at all times and knows how to administer it. In the event that your child suffers an asthma attack and does not have his/her Inhaler, the school Emergency inhaler will be used. Please confirm that you give permission for the school to administer this in an emergency.(Required)

If your child is likely to suffer from an allergic reaction, it is the parent’s/carer’s responsibility to ensure that your child carries their epipen at all times. In the event that your child does not have his/her epipen, the school will administer their emergency epipen. Please confirm that you give permission for the school to administer this in an emergency.(Required)

Additional Information

Is there anything else you feel we should know to help us support your child’s education? If yes, please give details below:

Declaration

I confirm that the above information is accurate

Your Name (Parent/Carer):

Relationship to child:

Please provide an email address to which a copy of your form will be sent:

In this section

Student Information Form

Privacy Notice

Student Details

Siblings at Pinner High School

Parent / Legal Guardian Details with whom the child lives

Other Parent / Legal Guardian

Additional Contact

Student Medical Information

Medical Conditions

Medication

Ethnicity

Religion

English as an Additional Language

Pupil Premium

Free School Meal Eligibility Information

Meals

Special Educational Needs

School History

Consents

Photographic Consent

Educational Visit Consent

Medical Consents

Additional Information

Declaration