1. Child/Children Names: *

3. Address (Please include house name and number): *

Please give details of all persons who have parental responsibility and anyone else you wish to be contacted in an emergency. Place them in the order that you wish for them to be contacted.

Parent/Guardian - Priority 1

5. Relationship to Pupil, e.g parent: *

8. Title: *

Mrs

11. Home Telephone Number: *

12. Mobile Number: *

Parent/Guardian - Priority 2

16. Relationship to pupil, e.g parent: *

19. Title: *

Mrs

22. Home Telephone Number: *

23. Mobile Number: *

Parent/Guardian - Priority 3

27. Relationship to pupil, e.g parent: *

30. Title: *

Mrs

33. Home Telephone Number: *

34. Mobile Number: *

38. Medical Practice: *

39. Telephone Number: *

40. Address of Medical Practice: *

41. Medical Information: *

42. Special Dietary Needs: *

44. Home Language: *

46. Travel Arrangements - Tick box of appropriate choice: *

Bus

Walk

Car

Data Protection Act 1998: The School is registered under the Data Protection Act for holding personal data. The school has a duty to protect this information and to keep it up to date. The School is required to share some of the data with the Education Authority and with the Department of Education.

47. Please indicate consent for your child to be included on our School Website, Facebook & Instagram Page. Our class teachers share learning acheivements and class celebrations on these platforms to include you in their learning journey. *

YES

49. Date: *

YYYY

Data Collection Form 2024-2025