DATA COLLECTION SHEET
NORRIS BANK PRIMARY SCHOOL

Surname:	

	Legal Surname:		
Forename:	

	Middle name:		
Chosen name:	

	Gender:		
Date of Birth:	

	Year Group:		
		Reg Group:

Address:		

Post Code:	

Telephone:	

Email:	

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.

Priority	Name / Relationship	Home Address / Phone / Mobile 	Work Address Phone / Email	
1

	

			
2

	

			

Travel Arrangements		
	
	Bicycle		Train		Car/Van		Walk		Taxi		School Bus		Car Share	
	London Underground		Public Bus Service		Metro/Train/Light Rail		Other	

Dietary Needs	
	
Dietary Preferences	
	
Meal Arrangement	
                       	School Meal Paid  /  Free School Meal  /  Packed Lunch    (circle as appropriate)	

Medical Practice:	

Address:		

Telephone Number:	

Medical Condition(s)

	
This may be shared with the school nurse.	

Medical Note(s)	

	

Ethnicity:                          

Home Language:

First Language: 

		Country of Birth:

Religion: 

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 Local Authority and with the DCSF.	

Signature: ……………………………………………………

	
Date: ……………………….