School Registration & Consent Form | Date Palm Primary

Posted on Jun 27, 2024 in Law & Jurisprudence

School Registration Form

Preferred Start Date: January 10, 2022

Student Details

:

Surname:

 BOUHRARA

First Name:

  YAMIN

Address:

11 BLOCK D ABBEY ORCHARD STREET                

                                                                                            Post code:   SW1P 2LW                                   

Date Of Birth:

  08-01-2019

Male *

Female

Are you a permanent resident in the UK? 

 YES*

Languages spoken:

PORTUGUES* ARABIC* ENGLISH* 

Previous school

Date: From

To:

Name

Parents/Guardian Details

Parent/Carer Name:

 TANIA NASCIMENTO

Relationship to child:

 MOTHER

Contact No:

 07562335265

Email Address

 yamin01@protonmail.com

DOB

 11/01/1990

NI Number

 SN285170C

Parent/Carer Name:

 YOUSSEF BOUHRARA

Relationship to child:

 FATHER

Contact No:

 07562335265

Email Address:

 yamin01@protonmail.com

Do you have parental responsibility?  YES

Do you have parental responsibility? YES

Details of other siblings currently enrolled at Date Palm Primary

Name

Age

Year

Medical Information

Does your child have any medical conditions, illnesses or allergy requirements:

 NO

Do you have any medical conditions or illnesses that the school should be made aware of:

 NO

Special Education Needs

Does your child have any special educational need (learning, physical, behavioural): YES / NO   Please give details:

 NO

Please give details of any other services that have been involved with your child (e.g. Social Services, Educational Psychologist, CHAMS, CAF etc.)

Name

Service

Details

If you would like to share any additional Information, please do so here:

Emergency Contact Details (other than parents/guardian)

Name

Relationship

Aunt

Tel:

Signature

Name

Relationship

Grandad

Tel:

signature

Declaration

  1. I understand that submitting this application does not guarantee my child a place.
  2. I will read school policy and procedures and agree to accept and abide by them.
  3. I understand that I/we the parent(s) together with the child on this application may be required to attend an interview.
  4. I declare the information submitted in this form, is accurate and correct and that any misleading information could jeopardise my child’s place at the school.

Signed 

Print Name        TANIA NASCIMENTO                                                      Date  19/11/2021    

Parent consent form

Trip consent

I understand that Date Palm Primary may arrange day trips that do not require parental consent.

Healthy eating consent

I agree to provide my child a healthy lunch every day. Please note that chocolates, crisps, biscuits, drinks are not allowed.

Homework contract

I agree to assist my child to complete their homework and will hand it in on the due date.

Internet Acceptable Use

I agree to the ‘Parent/Carer Acceptable Use Agreement’ (See Appendix A) and give permission for my child, to have access to the internet and to ICT systems at school.

Recording & Use of Images

During the course of the school year, we may sometimes wish to take photographs or video recordings of children within school or on school trips, either for our own records, for use as part of our learning curriculum or for inclusion in our promotional material such as the school prospectus and our website. 

Agree

Disagree

I agree for Date Palm to use my child’s photograph/, first name and year group in and around school, in places that might be seen by visitors or individuals using the school premises.

I agree for Date Palm to use my child’s photograph for educational purposes (e.g. portfolio of evidence)

I agree for Date Palm to use my child’s photograph in the school prospectus and other publications we produce for promotional purposes.                               

I agree for Date Palm to use my child’s image on the school website. 

I agree for Date Palm to my child’s photograph on our school communication app (bloomz).           

I agree for Date Palm to use my child’s photograph on our school Instagram page.                      

I agree for Date Palm to record my child’s image on video or webcam.

I agree for Date Palm to use my child’s first name alongside the image in the media.  

I agree for Date Palm to display my child’s medical condition on the medical board.

Yes

Note:  You have the right to withdraw consent at any time. You also have the right to erasure. Should you wish to do so, please speak to the school administrator.

List of family and friends allowed to collect your child

Please list below names and contact numbers of people who you consent to pick up your child from Date Palm Primary

Name

Relationship

Telephone

Signature

Signature of parent/guardian _________________ Date_________________

Medical Declaration Form

NAME OF CHILD: ____________________

NAME OF PARENT/GAURDIAN ____________________

GP NAME: ________________________

GP TELEPHONE: ________________________________

GP ADDRESS: _____________________________________________________________________________________

_____________________________________________________________________________________


MEDICAL HISTORY: _____________________________________________________________________________________

_____________________________________________________________________________________


CURRENT MEDICAL CONDITIONS: _____________________________________________________________________________________

_____________________________________________________________________________________


MEDICATIONS: _____________________________________________________________________________________


IS YOUR CHILD UPTO DATE WITH IMMUNISATIONS (THIS WILL BE IN YOUR CHILD’S RED BOOK):

YES          NO       (Please circle)

FOOD ALLERGIES(PLEASE DETAIL ALL ALLERGIES AND SEVERITY OF ALLERGY I.E. IF IN CLOSE CONTACT): _____________________________________________________________________________________

_____________________________________________________________________________________

MEDICATION FOR ALLERGIES: _____________________________________________________________________________________

_____________________________________________________________________________________

I GIVE PERMISSION FOR DATE PALM STAFF TO ADMINSTER MEDICATION IF NEEDED

(Parents/Guardian will be contacted prior to administration unless it is a regular prescribed medication)

I GIVE PERMISSION FOR EMERGENCY MEDICAL CARE TO BE ADMINISTERED IN MY ABSENCE

SIGNATURE OF PARENT/GUARDIAN __________________________________ DATE_____________________

Please return application form to:

admin@datepalmprimary.com

Office Use Only

Date Received:

Checked by:

Accepted:

Birth certificate Yes No          Deposit  paid                Yes No

Year Group:    Nursery  Reception   Year 1   Year 2   Year 3   Year 4   Year 5    Year 6     

Monitoring information

Date Palm Primary Ltd has adopted an Equality and Diversity Policy and is committed to ensuring equality of opportunity in employment. To ensure that it is working properly, all applicants are asked to provide the following information.

Female                       Male                                                     Date of birth

Ethnic background

         White

British                 Irish                       Any other white background, please specify

         Mixed

White and Black African                                 White and Black Caribbean

White and Asianother                                                    

         Asian or Asian British

Indian       Pakistani     Bangladeshi      other                                                     

         Black or Black British

Caribbean         African     Somali

         Chinese or other ethnic group

Chinese               other                                                        

Main Home Language – Please tick the one category.

Arabic                

Bengali              

Somali                

English               

French                 

Guajarati            

Hindi                     

Italian                   

Norwegian         

Other (please specify)

Polish                   

Punjabi                

Spanish               

Turkish                

Urdu                     

Additional Home Language(s) – Please List:

Advertising monitoring

How did you find out about Date Palm Primary?

APPENDIX A

Parent / Carer Acceptable Use Agreement

Digital technologies have become integral to the lives of children and young people, both within outside school. These technologies provide powerful tools, which open up new opportunities for everyone. They can stimulate discussion, promote creativity and stimulate awareness of context to promote effective learning. Young people should have an entitlement to safe internet access at all times.

This Acceptable Use Policy is intended to ensure:

  • that young people will be responsible users and stay safe while using the internet and other communications technologies for educational, personal and recreational use.
  • that school systems and users are protected from accidental or deliberate misuse that could put the security of the systems and users at risk.
  • that parents and carers are aware of the importance of online safety and are involved in the education and guidance of young people with regard to their on-line behaviour.

The school will try to ensure that students will have good access to digital technologies to enhance their learning and will, in return, expect the students to agree to be responsible users. A copy of the Student Acceptable Use Policy is attached to this permission form, so that parents / carers will be aware of the school expectations of the young people in their care.

Parents are requested to give written permission using the example below to show their support of the school in this important aspect of the school’s work.

Parent / Carer Permission

I understand that the school has discussed the Acceptable Use Agreement with my child and that they have received, or will receive, online safety education to help them understand the importance of safe use of technology and the internet – both in and out of school.

I understand that the school will take every reasonable precaution, including monitoring and filtering systems, to ensure that young people will be safe when they use the internet and systems. I also understand that the school cannot ultimately be held responsible for the nature and content of materials accessed on the internet and using mobile technologies.

I understand that my child’s activity on the systems will be monitored and that the school will contact me if they have concerns about any possible breaches of the Acceptable Use Policy.

I will encourage my child to adopt safe use of the internet and digital technologies at home and will inform the school if I have concerns over my child’s online safety.