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Admissions Form

After you have been offered a place you must fill in this form before your child can start nursery school.

This is not the application form!

Before you begin, please read about online safety and how we use photos in school at:
www.fans.waltham.sch.uk/screens-photos-data

To fill in the form you will need:
- your National Insurance or NASS number
- your child's Red Book
- your GP's address
- the name and phone number of someone we can contact if there is an emergency and we aren't able to get in touch with you
- the names and addresses of anyone who you already know will sometimes collect your child
- a cup of tea, or your favourite alternative

About your child

Which school has offered them a place?*Church Hill Nursery SchoolLow Hall Nursery School

First name (as on birth certificate)* First name by which the child is known (if different from their birth certificate) Middle name(s) Family name (as on birth certificate)* Date of birth*

Gendergirlboy

Religion in the family, or none, or leave blank Select your child's ethnicity or choose 'prefer not to say'*

Health

Doctor's name/GP Practice name Doctor/GP address Doctor/GP post code Doctor/GP phone number Health visitor's name Health visitor's phone number Date of last tetanus injection Date of last development check: 2 year old check/last check with a health visitor or GP Does your child have any particular health considerations? Please give details and any special requirements or reasonable adjustments the school needs to make to support the child’s needs, e.g. EpiPen, inhaler. Please note: we require an IHP (Individual Healthcare Plan) before we can administer medications

	yes	no
Does your child receive Disability Living Allowance?

Does your child have any non-food allergies? e.g. penicillin, plasters, anaesthetic, wasp stings/insect bites? Please provide a doctor’s note with details.

If your child develops a particular health need while at our school, please talk to their Key Person about it so we can support them.

Dietary requirements

Does your child have any food allergies? If yes, what are they: As above, we require an IHP before we can administer medication Please select one of the following

	yes
vegetarian
vegan
eats meat (note: all meat served in school is halal)
other

If ;other', please give details

Parent/carer information

If you have a code for your 2-year old's free 15-hour place, or for your 3-year old's free 30-hour place, enter it here:

Eligibility code: Main contact: first name* Main contact: family name* Main contact: date of birth* Main contact: National Insurance or NASS number

Please confirm you have parental responsibility for this child*I doI do not

Second contact: first name Second contact: family name Second contact: date of birth Second contact: National Insurance or NASS number

Please confirm if the second contact has parental responsibility for this childThey doThey do not

We ask for this information:
1. so that the Local Authority, the London Borough of Waltham Forest, can check your eligibility for funding
2. so that the school can apply to see if your child is eligible for Early Years Pupil Premium (EYPP).

You can read about EYPP here:
https://www.gov.uk/get-extra-early-years-funding

Emergency contact details, e.g. in case of an accident

Please tell us at least one person we can contact in an emergency if we are unable to contact you or the Second contact.

1. Emergency contact full name Best phone number for main emergency contact Alternative phone number for main emergency contact Address of main emergency contact Relationship to child of main emergency contact 2. Alternative emergency contact full name Best phone number of alternative emergency contact Alternative phone number of alternative emergency contact Address of alternative emergency contact Relationship to child of alternative emergency contact

Other people whom you permit to collect your child e.g. for play dates

1. First name and family name Relationship to child If they have a disability, are there any reasonable adjustments we can make to welcome them? 2. First name and family name Relationship to child If they have a disability, are there any reasonable adjustments we can make to welcome them?

Note: you are disabled under the Equality Act 2010 if you have a physical or mental impairment that has a substantial and long-term (12 months or more) negative effect on your ability to do normal daily activities.

Person/people not authorised to collect or have access to your child

1. First name and family name 2. First name and family name Context, e.g. injunction numnber

Permissions and consents

Emergencies*

	yes	no
I give permission for my child to be taken to hospital for treatment in the event of an emergency.

Outings*

	yes	no
I give permission for my child to be taken on local outings.

Photos and videos: school staff are allowed to take photos and videos as part of their observational records. If we want to make these images public, or use them for a different purpose, we need your consent. Occasionally we employ a photographer to take photos, and we need your consent to do this too.*

	yes	no
I consent to my child's learning record, which contains photos taken of them as a record of their education, being stored in a place where other families could see it.
I consent to photographs of my child being used in displays in school and on their name card.
I consent to photographs and videos that include my child being shared on the password-protected learning platform, Class Dojo.
I understand that the photos and videos I see on Class Dojo are accessible only to families from our school, and I will not share them.
I give permission for my child to have photos/videos taken by a photographer engaged by the school and for these images and the photos taken by school staff to be used in the school prospectus, on the school website, and on leaflets and posters advertising activities run by school.
I understand that I can request to see images taken at any time, and will do so in writing.
I have discussed this with my child and they are happy to be photographed, although I understand that at any time should they refuse or become upset, no photographs will be taken.

Photos and videos you take*

	I agree	I don't agree
I will not take photographs/videos of other children or staff at school events without the consent of the staff or the children’s parents/carers.
I will not share any photographs/videos of other children or staff I have taken at school events without the consent of the staff or the children’s parents/carers, and understand that there may be cultural or legal reasons why this would be inappropriate or even dangerous..

Internet and IT*

	yes	no
I understand that in school the only part of the internet that is accessible is filtered by the London Grid for Learning firewall. I accept that on very rare occasions these precautions may fail and the school cannot be held responsible for the nature and content of materials accessed, however I understand that the school will do everything in its power to support children if this should happen.
I have read the 4 “Be Safe Online” rules on the e-safety page of this website and I will talk them through with my child, helping them to understand how they can keep themselves and others safe online.
I give permission for my child to use the internet when supervised.
I will not use my mobile phone on school premises.

Jewellery and precious things*

	I accept	I don't accept
I accept that if I allow my child to wear jewellery it might get lost and they might get hurt by it, and that if they bring precious things into school they might lose them.

During the COVID-19 pandemic*

	I agree	I don't agree
I will not allow my child to bring any personal items into school
I will contact the school immediately if my child develops either a high temperature, a new continuous cough or loses their sense of smell or taste, and agree with school what steps must be taken.

My information

	yes	no
I consent to the school contacting me using my: • home and mobile phone numbers (including by text message) • email address • postal address
I consent to being contacted by school about these things: • raising extra money to continue to improve the experience my child has at school • to keep me in the loop with what’s happening at school • to let me know about extra-curricular activities on offer for my child
I give permission to the Forest Alliance of Nursery Schools to use the data I have provided here to apply for Early Years Pupil Premium.

I understand that I can change my mind at any point about the consents I have given or withheld on this form, and will let the school know by emailing school@churchhill.waltham.sch.uk, or school@lowhall.waltham.sch.uk, calling the school on 020 8520 4919 (Church Hill) or 020 8520 1689 (Low Hall), or calling into the school office.*I understandI don't understand

Please enter your email address, so that you can be sent a copy of your answers:

Please let us know as soon as possible if any of the information you have given us on this or any other form changes.

I consent to the Forest Alliance of Nursery Schools storing and sharing the information I have provided here in accordance with their Privacy Policy, in particular to contact me about my child, send me information about the schools, and to secure funding for my child's education and care.*I consentI don't consent

Read our Privacy Policy by clicking/tapping 'Privacy Notice' at the bottom of this page

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