Data Collection Sheet 21/22

Please fill in all information about your child below. You will need to complete this yearly. You should inform school of any changes that occur throughout the year so we can update your child's file. Thank you.

Child's Full Name* Date of Birth* Address - including postcode*

Out of School visits:

I give permission for my child to take part in out of school visits during September 2021 – July 2022. Please answer Yes/ No*

Photographs / Video Recordings

I give permission for photographs or video recordings to be taken of my child during the course of school activities during September 2021 – July 2022. I understand this may also include my child’s name/or photograph being published on the school website/Twitter although never the two together. Please answer Yes/ No.*

Dietary Requirements:

Does your child have any dietary requirements e.g; Religious, allergies etc: If none - please say none.*

Medical: Does your child have any medication conditions e.g; Asthma, any allergies that we should be aware of:

Medical Condition: (if none - please say none) :* Medication Required: (if none - please say none) :* Doctor’s Name:* Doctor's Surgery Name/ Address :* I agree to my child receiving appropriate medication and treatment as instructed in any medical emergency as considered necessary by the medical authorities present. I also understand that it is the Parent / Guardian’s responsibility to keep school informed of any changes or updated circumstances relating to this document. Please answer Yes/ No :*

Emergency Contact Information

Please enter the names of 3 contacts for your child. The first contact should be the main contact and also include an email address. Thank you.

Contact 1

Name:* Relationship to child:* Address - including post code: (if same as child - please state, same as child)* Telephone 1:* Telephone 2: Email Address*

Contact 2

Name:* Relationship to Child:* Address - including postcode:* Telephone 1:* Telephone 2:

Contact 3

Name:* Relationship to child:* Address - including postcode : Telephone 1:* Telephone 2:

St John's Catholic Primary School