Esher Church of England High School

Student Personal Information

Legal Forename* Preferred Forename* Middle Name(s) Legal Surname* Preferred Surname* Date of Birth*

Gender*MaleFemale

Home Address* Contact Number*

Any other ethnic group (please state)

Religion* Country of Birth* Nationality* First Language* Home Language* Date of Arrival in the UK (if applicable)

Does your student have Asylum status?*NoAsylum SeekerRefugee

In Care?*YesNo

Adopted from Care?*YesNo

If yes please provide evidence

Special Guardianship/Residency Order in Place?*YesNo

If yes please provide evidence

Service Student (Parent in the armed forces?)*YesNo

Parent/Guardian Information

Please give details of all persons who have parental responsibility and anyone else you wish to be contacted in an emergency. Please place them in the order that you wish for them to be contacted (continue on a separate sheet if necessary). You should also give the details of non-resident parents, who have the right to certain information, e.g. reports/residential trip letters which will be sent to them direct.

Full Name 1*

Gender*MaleFemale

Parental Responsibility?*YesNo

Relationship to Student* Address* Home Telephone Number* Work Telephone Number* Mobile Telephone Number* Email Address*

Full Name 2*

Gender*MaleFemale

Parental Responsibility*YesNo

Relationship to Student* Address* Home Telephone Number* Work Telephone Number* Mobile Telephone Number* Email Address*

Other Contact Details

Full Name 3*

Gender*MaleFemale

To be used as Emergency Contact?*YesNo

Address* Home Telephone Number* Work Telephone Number* Mobile Telephone Number* Email Address*

Information About Provision

Current School* Name of sibling(s) currently at Esher High School

Special Educational Needs and Disabilities

Is your student currently on the SEND Code if Practice?*YesNo

If yes, please tick one box belowAdditional SEN supportStatement/Education Health Care Plan

Lunch Arrangement

*Free School MealPaid School MealSandwiches

Dietary Needs

Travel Arrangements

Medical

GP's Name* GP's Address* Telephone Number* Medical Condition(s)

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 Department for Education.

The GDPR (General Data Protection Regulations) comes into force on 25 May 2018. Our updated Privacy Policy will be available on our school website from that time at www.esherhigh.surrey.sch.uk. If you require a hard copy of the new Privacy Policy, please contact the Office after this time.

Signature of Parent/Guardian* Date*

Esher Church of England High School

Form 2

Student Personal Information

Parent/Guardian Information

Other Contact Details

Information About Provision

Special Educational Needs and Disabilities

Lunch Arrangement

Dietary Needs

Travel Arrangements

Medical

Data Protection Act 1998

Cookie Policy