Legal Surname (if different from above)

Preferred Forename (Name child is to be known by):

Gender

Male

Female

Date of Birth

YYYY

Derrychrin PS have a Private Parent Text Messaging Service linked to the Schools NI app to enable the school to contact parents/guardian in the event of an emergency. The first preference contact details will be added to the messaging service.

Please give details of all persons who have parental responsibility and anyone else you wish to be contacted in the event of an emergency.
Place them in order of contact priority. For example, you may wish to put the mother or father in the 1st and 2nd boxes.

List these in order of priority to be contacted.
Parent/Guardian 1 - First point of contact
Parent/Guardian 2 - Second point of contact
OR
Other Contact

Parent/Guardian 1 (Must be completed)

Parent/Guardian 1 Title

Mrs

Miss

Parent/Guardian 1 Surname

Parent/Guardian 1 Forename

Relationship to Child

Parent

Guardian

Step Parent

Foster Carer

Grand Parent

Other (Please Specify Below)

Mobile Number ESSENTIAL - The main form of contact will be this number.

Email Address (Much of our communication is now through email)

Parent/Guardian 2 (if applicable)

Parent/Guardian 2 Title

Mrs

Miss

Parent/Guardian 2 Surname

Parent/Guardian 2 Forename

Relationship to Child

Parent

Guardian

Step Parent

Foster Carer

Grand Parent

Other (Please Specify Below)

Mobile Number (ESSENTIAL)

Email Address (Much of our communication is now through email)

Other Contact (Must be completed)

Other Contact Title

Mrs

Miss

Other Contact Surname

Other Contact Forename

Relationship to Child

Parent

Guardian

Step Parent

Foster Carer

Grand Parent

Other (Please Specify Below)

Mobile Number (ESSENTIAL)

Please provide information on travel arrangements for your child.

Please select travel arrangements for your child.

Car

Walk

School Bus

Other (Please Specify Below)

This section gives information about lunchtime arrangements for your child on most occasions in school.

What meal arrangement will your child receive mostly in school?

Free School Meal

Paid School Meal

Packed Lunch

Please provide as much information as you can.

Address of Medical Practice

Medical Information/Medical Conditions (i.e diabetic/asthmatic/allergies)

Special Dietary Needs

Previously registered with a Sure Start project. *

Yes

Do not know

Attended a Sure Start project for 2-3 year olds. *

Yes

Do not know

Child's Home Language *

General Data Protection Regulation 2018: The school is obliged to comply with the General Data Protection Regulation (GDPR). We will process your personal information on the legal basis that it is part of our GDPR policy to do so. We have 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 Education Authority, with the Department of Education (DENI) and Public Health Authority (PHA). A copy of the GDPR policy is available on our website. The school is required to share some of the data with the Education Authority and the Department of Education. To enable us to comply with our obligations under GDPR, we require your consent to hold the information included in this form. You will be asked to complete a new form at the start of each academic year while your child attends this school. If your circumstances change, i.e. change of address, you should contact the school office to request a new form. This form should be signed by someone with parental responsibility wherever possible. If you have provided details of anyone other than yourself, please let them know that the school holds their details.

Yes

Pupil Data Collection Information