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New Joiner Information Form
New Joiner Information Form
"
*
" indicates required fields
1
Your details
2
Child's details
3
Emergency Contacts
4
Health & Diet
5
Photo consent
6
Who's filling in this form?
*
First
Last
Relationship
*
Select
Mother
Father
Step-Mother
Step-Father
Nanny
Sibling
Aunt
Uncle
Neighbour
Grandparent
Guardian
Family friend
Au Pair
Personal/Executive Assistant
Basic Information
Child's name
*
First
Middle
Last
Date of birth
DD slash MM slash YYYY
Please upload a photograph of your child
*
Max. file size: 48 MB.
The photograph will be used to identify your child on our school database.
Year group
*
Select
Nursery (Cygnets)
Pre-Reception (Swans)
Reception
Year 1
Year 2
Year 3
Year 4
Year 5
Year 6
Year 7
Year 8
Child's first language:
*
Other languages spoken at home (if applicable):
Nationality & Visas
Please upload a copy of your child's passport
*
Max. file size: 48 MB.
Nationality
*
If not a UK citizen, details of parental visa status:
If not a UK citizen, please upload Visa evidence (BRP card, notice of Leave to Remain, etc.)
Max. file size: 48 MB.
Address & Living Arrangements
Child's Primary Address
*
Street Address
Address Line 2
City
Post Code
Aland Islands
Albania
Algeria
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean
Brunei Darussalam
Bulgaria
Burkina Faso
Burma
Burundi
CHINA
Cambodia
Cameroon
Canada
Cape Verde
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
Christmas Island
Coco(Keeling) Island
Columbia
Comoros
Congo
Congo (DRC)
Cook Islands
Costa Rica
Croatia (Hrvatska)
Cuba
Curaçao
Cyprus
Czech Republic
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Island
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern and Antarctic Lands
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Grand Cayman
Greece
Greenland
Grenada
Guadeloupe
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
HONG KONG
Haiti
Heard Island and McDonald Islands
Holy See (Vatican City State)
Honduras
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
JAPAN
Jamaica
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Republic of
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Macedonia, the former Yugoslav Republic of
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
NIGERIA
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Niue
Norfolk Island
Norway
Oman
Pakistan
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Qatar
RUSSIA
Reunion
Romania
Rwanda
Saint Barthelemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin (French part)
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Saudi Arabia
Senegal
Serbia and Montenegro
Seychelles
Sierra Leone
Singapore
Sint Maarten (Dutch part)
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Korea
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Swaziland
Sweden
Switzerland
Syria
São Tomé and Principe
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States of America
Uruguay
Uzbekistan
Vanuatu
Venezuela
Vietnam
Virgin Island(British)
Wallis and Futuna Islands
Western Sahara
Yemen
Zambia
Zimbabwe
Country
With whom do they live at this address?
*
Please tick this box if your child lives at multiple addresses
Yes
Child's Secondary Address
Street Address
Address Line 2
City
ZIP / Postal Code
Aland Islands
Albania
Algeria
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean
Brunei Darussalam
Bulgaria
Burkina Faso
Burma
Burundi
CHINA
Cambodia
Cameroon
Canada
Cape Verde
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
Christmas Island
Coco(Keeling) Island
Columbia
Comoros
Congo
Congo (DRC)
Cook Islands
Costa Rica
Croatia (Hrvatska)
Cuba
Curaçao
Cyprus
Czech Republic
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Island
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern and Antarctic Lands
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Grand Cayman
Greece
Greenland
Grenada
Guadeloupe
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
HONG KONG
Haiti
Heard Island and McDonald Islands
Holy See (Vatican City State)
Honduras
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
JAPAN
Jamaica
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Republic of
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Macedonia, the former Yugoslav Republic of
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
NIGERIA
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Niue
Norfolk Island
Norway
Oman
Pakistan
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Qatar
RUSSIA
Reunion
Romania
Rwanda
Saint Barthelemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin (French part)
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Saudi Arabia
Senegal
Serbia and Montenegro
Seychelles
Sierra Leone
Singapore
Sint Maarten (Dutch part)
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Korea
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Swaziland
Sweden
Switzerland
Syria
São Tomé and Principe
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States of America
Uruguay
Uzbekistan
Vanuatu
Venezuela
Vietnam
Virgin Island(British)
Wallis and Futuna Islands
Western Sahara
Yemen
Zambia
Zimbabwe
Country
With whom do they live at this address?
Please share any information you think we need to know about your child's living arrangements and schedule:
Emergency Contact Information
Emergency Contact 1: Name
*
Dr
Miss
Mr
Mrs
Ms
Prof.
Rev.
Prefix
First
Last
Relationship
*
Select
Mother
Father
Step-Mother
Step-Father
Nanny
Sibling
Aunt
Uncle
Neighbour
Grandparent
Guardian
Family friend
Au Pair
Personal/Executive Assistant
Mobile Phone
*
Work Phone
Home Phone
Email
*
Notes
Emergency Contact 2: Name
*
Dr
Miss
Mr
Mrs
Ms
Prof.
Rev.
Prefix
First
Last
Relationship
*
Select
Mother
Father
Step-Mother
Step-Father
Nanny
Sibling
Aunt
Uncle
Neighbour
Grandparent
Guardian
Family friend
Au Pair
Personal/Executive Assistant
Mobile Phone
*
Work Phone
Home Phone
Email
*
Notes
Add a third Emergency Contact?
Yes
Emergency Contact 3: Name
First
Last
Phone
Email
Relationship
Select
Mother
Father
Step-Mother
Step-Father
Nanny
Sibling
Aunt
Uncle
Neighbour
Grandparent
Guardian
Family friend
Au Pair
Personal/Executive Assistant
Immunisations
Please select all immunisations your child has had.
*
Diphtheria
Tetanus
Polio
Whooping cough
MMR x 2
Meningitis C
None of the above
Select All
If your child has not had one of these immunisations or completed the course (if relevant), please let the school office know if and when your child is immunised.
Immunisation Date: Diptheria
DD slash MM slash YYYY
Immunisation Date: Tetanus
DD slash MM slash YYYY
Immunisation Date: Polio
DD slash MM slash YYYY
Immunisation Date: Whooping Cough
DD slash MM slash YYYY
Immunisation Date: MMR (First dose)
DD slash MM slash YYYY
Immunisation Date: MMR (Second dose)
DD slash MM slash YYYY
Immunisation Date: Meningitis C
DD slash MM slash YYYY
Health
Please tick if your child has had any of the following:
*
None of the below
Mumps
Measles
German measles
Chicken pox
Whooping cough
Scarlet Fever
Does your child suffer from any of the following? If the answer to any of the below is Yes, please select and give full details below.
*
None of the below
Asthma
Hay fever
Eczema
Allergies (food, bites, antibiotics, anti-histamine, suncream)
Epilepsy / fits / convulsions
Serious illness or operation
Diabetes
Details
Medication
Do you give consent for your child to be given prescribed medication by staff at Heathside School Hampstead, eg: inhalers if required?
*
Yes
No
Is your child allergic to plasters or antiseptic wipes?
*
Yes
No
(Unless the school has been informed that your child is allergic to either plasters or antiseptics, if an accident should occur the wound will be cleaned with water and/or an antiseptic wipe and a plaster applied if necessary.)
Has your child been prescribed an epipen?
*
Yes
No
Please note that the school requires two epipens for any child for whom an epipen has been prescribed – one to be kept in the school office and the other to be kept in the child’s classroom.
Please note below any current serious health conditions of which the school should be aware.
Diet
Does your child have any allergies, or medical or other needs in terms of their diet?
*
Yes
No
If you answered yes, please give details below.
If so, please state them here. Any such dietary requirement must have been recommended by a medical doctor or be due to religion or belief (as protected by law).
Photo consent
Occasionally, we may take photographs of the children at our school. We may use these images as part of our school displays and sometimes in our school’s prospectus or in other printed publications that we produce. We may also use them on our school website and make video or webcam recordings for school-to-school conferences, monitoring or other educational use.
If we use photographs of individual pupils, we will not use the name of that child in the accompanying text or photo caption. If we name a pupil in the text, we will not use a photograph of that child to accompany the article. If a child has won an award and the parent would like the name of their child to accompany their picture, we will obtain permission from the parent before using the image.
From time to time, our school may be visited by the media who will take photographs or film footage of a visiting dignitary or other high-profile events. Pupils will often appear in these images, which may appear in local or national newspapers, approved websites or on televised news programmes. To comply with the General Data Protection Regulations (GDPR), we need your permission before we can photograph or make any recordings of your child.
Please answer the questions below, then sign and date the form where shown. You can change your preferences any time by emailing: admissions@heathsideschoolhapmstead.com.
Do you give consent for us to use your child’s photograph for INTERNAL marketing purposes? For example, the school newsletter and other materials only distributed to current parents.
*
I consent
I do not consent
Do you give consent for us to use your child’s photograph for EXTERNAL marketing materials? For example, the school website, social media, or printed prospectus.
*
I consent
I do not consent
Signature
*
Consent for trips and off-site activities
I consent for my child to take part in school trips and other activities that take place off school premises.
*
Yes
No
I consent for my child to be given first aid or urgent medical treatment during any school trip or activity.
*
Yes
No
Please note the following important information before signing this form:
● The trips and activities covered by this consent include:
o all visits which take place during the term time, holidays or a weekend such as chess or sports fixtures
o all off-site activities for Early Years classes
o playtime visits to Hampstead Heath
● The school will send you information about each trip or activity before it takes place.
● You can, if you wish, tell the school that you do not want your child to take part in any particular school trip or activity.
Written parental consent will not be requested from you for the majority of off-site activities offered by the school – for example, year-group visits to local amenities – as such activities are part of the school’s curriculum and usually take place during the normal school day.
Signature
*