Family information form

This is not the application form!

Fill in this form only after you have been offered a place.

You must fill it in before your child can start nursery school.

Before you begin, you must do our 6 short lessons in online safety and read about data and photos in school and online learning.

To fill in the form you need:

your National Insurance or NASS number and the same for the other parent/carer, if there are two of you in this role. We need these to apply for the funding to educate your child.

your child's Red Book

your GP's address

the name and phone number to call if there is an emergency and we can't reach you

the name and address of anyone else who will 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)* Middle name(s) Family name (as on birth certificate)* Child's nick-name/short name (if different from their birth certificate) Date of birth*

Gender*girlboyitem textprefer not to say

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

Health and development

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 2-year-old development check or last check with a health visitor or GP Does your child have any particular health considerations? Are they developing as you expect? Do you have any concerns? E.g. Sight and hearing? Mobility? Can they express their needs using words? Can people outside your immediate family understand them? Has anyone from another setting or agency spoken to you about possible further investigations into their development? Please tell us, as we need to plan any special requirements or reasonable adjustments to make to support their needs.

	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? Note: we require an IHP (Individual Healthcare Plan) before we can administer medication including EpiPens and inhalers.

If your child develops a health or development need while they are with us, please talk to their Key Person about it, so we can support them and you.

Dietary requirements

What diet does your child follow?* Does your child have any food allergies? Is there anything they cannot eat? Please tell us here. As above, we require an IHP before we can administer medication.

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 (put 'n/a' if not appropriate)* Second contact: family name (put 'n/a' if not appropriate)* Second contact: date of birth (put 'n/a' if not appropriate)* Second contact: National Insurance or NASS number (put 'n/a' if not appropriate)*

Please confirm if the second contact has parental responsibility for this child*They doThey do notNo second contact

Emergency contact: who do we call if we can't reach you?

Please tell us one or two friends, relatives or neighbours we can call in an emergency if we can't reach you or the second contact. NOT YOU!

First Emergency Contact full name Best phone number for first emergency contact Alternative phone number for first emergency contact Address of first emergency contact Relationship to child of first emergency contact If they have a disability, are there any reasonable adjustments we can make to welcome them? Second emergency contact full name Best phone number of second emergency contact Alternative phone number of second emergency contact Address of second emergency contact Relationship to child of second emergency contact 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.

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

First person OK to pick up your child, full name First person's relationship to your child If they have a disability, are there any reasonable adjustments we can make to welcome them? Second person OK to pick up your child, full name Second person's relationship to your child If they have a disability, are there any reasonable adjustments we can make to welcome them?

Anyone who is not authorised to collect or have access to your child

Full name of first person not OK to pick up or contact my child Full name of second person not OK to pick up or contact my child Context, e.g. injunction numnber

Permissions and consents

Emergencies:

In the unlikely event your child has an accident, we may need to take them to hospital and meet you there. We need your permission to do this.

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

Outings:

We sometimes take small groups of children on outings for example, to the library or the market. Please give your consent.

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

Jewellery and precious things:

Precious things can get lost, and jewellery can cause children to be hurt while playing.

Please answer*
	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.

Internet and IT

In school, children only go online occasionally. When they do, it is together with a grown-up, to follow up on particular questions or subjects that link to their learning.

The only part of the internet that is accessible in school is filtered by the London Grid for Learning firewall. On very rare occasions, these precautions may fail, and the school cannot be held responsible for the nature and content of materials accessed. However, the school will do everything in its power to support children if this should happen.

Please read about our online learning to find out more, and do our Six Short Lessons in e-safety to help you stay safe. Do Lesson 1 with your child.

Please answer*
	yes	no
I have done the Six Short Lessons in e-safety
I give permission for my child to use the internet together with an adult

Phones, photos, and occasionally videos

Photos and videos taken by school:

School staff are permitted to take photos and videos as part of our operation as a school. For example, we take photos and videos as part of the observational records of the children's learning which staff keep in their Special Books. You keep these books when your child leaves us.

If we want to use or share these images for something other than their education, we need your consent.

Please tell us what you consent to:*
	yes	no
I consent to my child's Special Book being stored in a place where other families might see it.
I consent to my child's photo being on their name card where other families will see it
I consent to photos and videos that include my child being shared on the password-protected learning platform, Class Dojo.
I consent to photos of my child being used in displays in school
I consent to photos of my child being used in the school prospectus
I consent to photos of my child being used on the school website
I consent to photos of my child being used in leaflets and posters advertising activities run by school

Your photos, videos and phones:

As well as not being polite, there may be cultural, safety, or legal reasons why it is inappropriate or even dangerous to take and/or share photos of other children or staff.

During the school day, we do not allow mobile phones in the nursery area.

Please agree to follow our phone and photo behaviour rules*
	I agree	I don't agree
I will not take photos/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 photos/videos of other children or staff I have taken at school events without the consent of the staff or the children’s parents/carers
I will not share the photos or videos I see on Class Dojo
I will not use my mobile phone on school premises.

Your information

The Forest Alliance of Nursery Schools is permitted to process information about you and your child as part of our operation as schools. For example, phoning you if your child becomes ill during the day. You can read more about what we do with your data in our Privacy Notice.

Our Local Education Authority, Waltham Forest Council, also holds data to carry out their functions, for example validating your eligibility code for 2-year-old or 30 hours of Free Early Years Education, or planning their special educational needs provision, and we share data with them. You can read more in their privacy notice at Free Early Education and Childcare Privacy Notice.

But there are some things for which we need your consent:

With your consent, Waltham Forest can apply for Early Years Pupil Premium (EYPP). This is additional funding paid to early years providers so they can provide extra teaching and learning facilities and resources designed to impact positively on a child’s progress and development.

With your consent, we can contact you about school activities that are not, from one point of view, educational, for example if we hold a fundraising disco.

Please decide:*
	yes	no
I consent for the information I have provided to be used to check eligibility for Early Years Pupil Premium
I consent to being contacted by school about what’s going on in school, fundraising for school and unusual things the school is planning.

You can change your mind at any point about the consents you have given or withheld on this form. Please will let the school know by emailing school@churchhill.waltham.sch.uk, or school@lowhall.waltham.sch.uk, or by calling the school on 020 8520 4919 (Church Hill) or 020 8520 1689 (Low Hall), or by calling into the school office.

Please let us know straight away if anything you have told us changes so we can correct our system and take best care of your child.

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