Lower school admission form (Years 7-11)

This admission form is only for those students who have a confirmed offer

All the rules and regulations you are confirming in this consent form can be found in the the Admissions section on the website and are also linked to the relevant question. Please read this information before submitting your admission form. A copy of this form will be emailed to you on submission.
Please complete the following information: (to be completed by parent/carer)
Student Legal Surname:* Student Legal Forename:* Student Preferred Surname: Student Preferred Forename: Student Middle Name: Date of Birth* Student Address:* Please enter Postcode* Priority contact 1 full name including title (this should be the main carer and the person the student lives with.*
Contact Type*MotherFatherCarerOther
Other Contact Type (ie step parent, grandparent, family friend) Contact 1 Occupation:* Please enter Address & Postcode if different to student: Mobile number (Priority Contact 1 )* Home number (Priority Contact 1) Work number (Priority Contact 1) Contact 1 email address: This email address will be used for school communications via Sims In-Touch unless advised otherwise in the Notes section at the end of this form: If no email available please state this* Priority contact 2 full name including title*
Contact TypeMotherFatherCarerOther
Other Contact Type (ie step parent, foster parent, grandparent) Contact 2 Occupation: Address & Postcode if different to above: Mobile number (Priority Contact 2)* Home number (Priority Contact 2) Work number (Priority Contact 2) Email address: Contact 2* Please advise if your daughter/ward has a sibling at the school please state their name and form: Please give details of any special custody arrangements and provide copies to the school of any court orders etc:
In an emergency, parent/carer will be contacted first - Please give full details of any other persons who you wish to be contacted should you not be available, in the order they should be contacted.
Contact 3: Name / Relationship to student / Full address / Contact number Contact 4: Name / Relationship to student / Full address / Contact numbers Please enter Medical Information: Medical Practice Name / Address / Telephone no:* Please enter Students Health problems/Allergies /Medication:
Does your child have a diagnosed Special Educational Need:*YesNo

Please tick all that are relevant:ASDADHDDyslexiaSPLDHearing impairmentVisual impairmentOther (detail below)
Additional Information: Is your daughter a young carer: (Please select from the dropdown):* Please advise travel arrangements for student: Bus with route no / Car /Taxi / Train / Walks / Cycle* Please give details of all previous schools attended: (most recent first):
Name of School: Date from: Date to:

Consent to photographs of student being used in School Marketing and Press Releases.
Occasionally photos of current students are used in the School prospectus, Newsletter, School Website or information screens and in Press Releases, Catering service for Biometrics etc. Submission of this form confirms your consent. Please advise in the notes section at the end of this form if you do not give consent.
Ethnicity Questionnaire:
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. The Information Commissioner (formerly the Data Protection Registrar) recommends that young people aged over 11 years old have the opportunity to decide their own ethnic identity. Parents or those with parental responsibility are asked to support or advise those children aged over 11 in making this decision, wherever necessary. Students aged 16 or over can make this decision for themselves.
Please tick ONE BOX ONLY to indicate the ethnic background of the student named above.*White BritishWhite IrishWhite Traveller of Irish HeritageWhite Gypsy/RomaWhite Any other White backgroundMixed White and Black CaribbeanMixed White and Black AfricanMixed White and AsianBlack or Black BritishBlack or Black CaribbeanBlack or Black AfricanAny other Black backgroundAsian or Asian BritishIndianPakistaniBangladeshiAny other Asian backgroundChineseAny other ethnic backgroundI do not wish an ethnic background category to be recorded

Religion:
Please tick most appropriate box:*BUDDHISTCHRISTIANHINDUJEWISHMUSLIMSIKHNO RELIGIONOTHER (Please specify below)I do not wish to answer this question
Enter other religion here
First Language:
Please refer to this document
From the above document please select the language to which your child was first exposed in their early childhood and which they continue to use or be exposed to at home or in your community:*
Pupil Premium Information:
The following information is required in order to ascertain whether your daughter/ward qualifies for Pupil Premium payment. Further information on Pupil Premium can be found on the school website.
Is either parent/carer a member of the armed forces?*YesNo

Is your daughter/ward a looked after child (social services)*YesNo

Is your daughter/ward currently entitled to Free School Meals or has she been in the last 6 years*YesNo

Is your daughter adopted*YesNo

Additional information: In order to take advantage of offers from universities for first generation graduates it would be helpful if you could confirm the following: Is either parent/carer educated to Degree level.*YesNo

Click here Biometric Consent for information on Biometric consent to the school for the biometrics of my child.
Please select if Biometric consent given:*I give consentI do not give consent

Does your daughter have broadband access at home*YesNo

Which device(s) does your daughter have access to at home*PC/IMACLaptopTabletSmartphoneNone

Is this device*For your daughters sole useShared with other family member

Emergency Closure Arrangements:
In the event of the school having to close early due to bad weather etc, all students will be SENT HOME unless you advise the school otherwise in writing.

Parent / Carer’s / Student Undertaking:
Please click to read the document in the Admission section detailing information pertaining to the following:
In accepting the place offered to my daughter (named above) at Blackfen School,
I and student undertake to abide by the school rules in respect of attendance, behaviour, uniform, photo consent, home & school study.
I and student have read and agree to the Internet rules and Internet permission and discipline .
I consent to Communication Sent Home via SIMs In Touch and to my contact details to be used for Sims In Touch communications.
Internet Permission: I and student agree to comply with the school’s Acceptable User Policy.
Data Protection: I (Parent/Carer) confirm that I have read the Privacy Notice.
Medical form for School Trips (local visits, day visits, evening and sporting activities):
I (Parent/Carer) confirm that I have read and understood the medical notice for School trips.
Home School Agreement: I and student have read and agree this document and that submission of this form is our agreement. (A paper copy will be issued for signing at a later date).
By clicking this box you agree to the terms and conditions as detailed above.*I the Parent/Carer agree

By clicking this box you agree to the terms and conditions as detailed above.*I Student agree
Notes: Please add any additional information you would like us to know here.