The Cathedral Church Of England Voluntary Aided Primary School
- Survey
On-Line Admission Form
Q1. Child's First Name
Q2. Child's Surname
Q3. Preferred First Name
Q4. Preferred Surname
Q5. Date of Birth
Q6. Date of entry to the country (if applicable)
Q7. Address
Q8. Post Code
Special Educational Needs
Q9. Does your child have Special Educational Needs or hold an Educational Health Care Plan (EHCP)?
No
Yes
Previous School / Nursery
Q10. Name of School / Nursery
Q11. Start Date
Q12. Finish Date
Q13. School / Nursery Address
Languages
Languages Spoken
Please list the languages spoken by the child and whether they are a first or home language.
The first language is the language a child was exposed to in their early years i.e mother tongue.
Home language is the language the child now speaks at home.
Q14. First Language
Q15. Home Language
Religion
Q16. Religion
No Religion
Buddhist
Christian
Hindu
Jewish
Muslim
Sikh
Other religion
Prefer not to say
Dietary / Medical Information
Pupil Premium : Free School Meal Eligibility. (Please note this is not the same as Universal Infant Free School Meals) is this child eligible for free school meals?
Q17. Pupil Premium: Free School Meal Eligibility Is this child eligible for free school meals?
No
Yes
Q18. Free School Meal Claimant If eligible, would you like to claim free school meals for this child?
No
Yes
Q19. Dietary Requirements Does this child have any special dietary requirements? E.g. vegetarian, halal, celiac, severe allergies
Q20. All known disabilities
Q21. Doctors Surgery / Practice Name (if not signed to a doctors surgery please mark N/A)
Q22. Doctors Surgery / Practice Address
Q23. Diagnosed Medical Conditions
None
Allergies
Asthma
Food intolerance
Visually Impairment
Heart Condition
Medical Care Plan
Other Condition
Q24. Further Details
Ethnicity
Q25. White
No
British
Irish
Traveller
Gypsy
Roma
Albanian (excluding Kosovan)
Italian
Kosovan
Greek/Greek Cypriot
Turkish/Turkish Cypriot
White Eastern European (including Bulgarian, Czech, Latvian, Lithuanian, Polish, Romanian, Russian, Slovak, Ukranian,)
White Western European (including French, German, Spanish, Portuguese, Scandinavian)
White other (Other children of White background not represented in the categories above)
Q26. Black or Black British
No
Caribbean (including Antigua & Barbuda, Bahamas, Barbados, Dominica, Grenada, Guyana, Jamaica, St Kitts & Nevis, St Lucia, St Vincent & Grenadines, Trinidad & Tobago)
Angolan
Congolese
Ghanaian
Nigerian
Sierra Leonian
Somali
Sudanese
Other Black African (including Black South African, Ethiopian, Rwandan, Ugandan, Zimbabwean)
Any other Black background (Other children of Black background not represented in the categories above, including Black Canadian, Black European, Black North American)
Q27. Mixed/dual background
No
White and Black Caribbean
White and Black African
White and Asian (including White and Bangladeshi, White and Pakistani, White and any other Asian background)
White and any other ethnic group
Other mixed background (Other mixed race children not represented in the categories above, including Asian and Black, Asian and Chinese, Asian and other ethnic group, Black and Chinese, Black and other ethnic group, Chinese and other ethnic group)
Q28. Asian or Asian British
No
Indian
Pakistani (including Mirpuri Pakistani, Kashmiri Pakistani and other Pakistani)
Bangladeshi
Nepali
African Asian (including East and South African Asians)
Other Asian (Other Asian children not represented in the categories above, including Kashmiri Other, Sinhalese, Sri Lankan Tamil)
Q29. Chinese
No
Hong Kong Chinese
Other Chinese (Other Chinese children not represented in the category above including Malaysian Chinese, Singaporean Chinese, Taiwanese)
Q30. Any other ethnic background
No
Afghanistani
Filipino
Thai
Any other ethnic group (children of ethnic backgrounds not represented in the categories above including, Palestinian, Kuwaiti, Jordanian, Saudi Arabian, Egyptian, Iranian, Iraqi, Japanese, Korean, Kurdish (from Iraq, Iran, Turkey), Central American, South American, Cuban, Belize, Lebanese, Malaysian (other than Malaysian Chinese), Moroccan, Polynesian, Fijian, Tongan, Samoan, Tahitian, Yemeni)
Q31. I do not wish an ethnic background category to be recorded.
Family Details and Living Situation
Q32. Looked after’ Status. (Child in care or being 'looked after')
No
Yes
Q33. Family In School (The names of siblings in the school, if any)
Q34. Traveller Status
No
Yes
Q35. Refugee Status
No
Yes
Q36. Armed Forces (A parent/s in the armed forces)
No
Yes
Primary Emergency Contact 1 (Parent / Carer)
Q37. Full Name
Q38. Gender
Male
Female
Q39. Relationship to the Child (ie Mother, Father)
Q40. Armed Forces
No
Yes
Q41. Permission to take home
No
Yes
Q42. Parental Responsibility
No
Yes
Q43. Address same as childs
No
Yes
Q44. Address if different from childs (please include door number and postcode).
Q45. Home Telephone Number
Q46. Work Telephone Number
Q47. Place of Work / Address
Q48. Mobile Number
Q49. Email Address
I consent to being contacted about/receiving school-related marketing, extracurricular and fundraising information. This may include PTA events, newsletters, before/after school clubs, educational brochures, products and local workshop information that may be of interest to you or your child. Consent may be withdrawn by contacting the school office.
Q50. Consent
No
Yes
Primary Emergency Contact 2 (Parent / Carer)
Q51. Full Name
Q52. Gender
Male
Female
Q53. Relationship to the Child (ie Mother, Father)
Q54. Armed Forces
No
Yes
Q55. Permission to take home
No
Yes
Q56. Parental Responsibility
No
Yes
Q57. Address same as childs
No
Yes
Q58. Address if different from childs (please include door number and postcode).
Q59. Home Telephone Number
Q60. Work Telephone Number
Q61. Place of Work / Address
Q62. Mobile Number
Q63. Email Address
I consent to being contacted about/receiving school-related marketing, extracurricular and fundraising information. This may include PTA events, newsletters, before/after school clubs, educational brochures, products and local workshop information that may be of interest to you or your child. Consent may be withdrawn by contacting the school office.
Q64. Consent
No
Yes
Contact 1 & 2 Declaration
General Data Protection Rules 2018 (GDPR): The school is registered under the Data Protection Act for collecting, storing and processing personal data. The school has a duty to protect this information and to keep it up to date. The information collected within this form will be used to register your child at The Cathedral School. The personal data we hold may be shared with:
• The Department for Education and other relevant organisations whom they nominate.
• Local Education Service and any other Local Education Authorities with whom the child becomes associated.
• Schools and Further Education establishments with whom the child becomes associated.
• Recognised health care and social work establishments with whom the child may become associated.
Privacy Notice
Further information can be found within our privacy notice, which is available on our website, at: https://www.cathedralschool.co.uk/office/privacy-notice
Parent / Carer 1
Q65. The information I have provided within this form is accurate and up to date.
No
Yes
Q66. I have read and understood the information provided within The Cathedral School's privacy notice.
No
Yes
Q67. FullName
Q68. Date
Parent / Carer 2
Q69. The information I have provided within this form is accurate and up to date.
No
Yes
Q70. I have read and understood the information provided within The Cathedral School's privacy notice.
No
Yes
Q71. Full Name
Q72. Date
In line with General Data Protection Regulations please see our Privacy Notice on our website. http://www.cathedralschool.co.uk/office/privacy-notice
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