SECTION A

Student details

SURNAME*

FORENAMES*

LEGAL SURNAME*

LEGAL FORENAME*

DATE OF BIRTH*

MALE/FEMALE* Select MALE FEMALE

HOME ADDRESS*

POST CODE*

HOME TELEPHONE NUMBER

PRIMARY SCHOOL ATTENDED*

DOCTOR’S NAME & ADDRESS*

MEDICAL INFORMATION: DOES YOUR CHILD SUFFER FROM ANY OF THE FOLLOWING? (PLEASE SELECT) ASTHMA MIGRAINE HEARING PROBLEMS PHYSICAL DISABILITY DIABETES HEART TROUBLE COLOUR BLINDNESS SIGHT PROBLEMS EPILEPSY

OTHER, PLEASE SPECIFY

PLEASE PROVIDE DETAILS IF YOU SELECTED ANY OF THE ABOVE AND INCLUDE DETAILS OF ANY MEDICATION TAKEN:

IDENTIFIED SPECIAL EDUCATIONAL NEEDS* Select YES NO

IF YES, PLEASE IDENTIFY WHAT STAGE

IS YOUR CHILD ELIGIBLE FOR FREE SCHOOL MEALS? (Documentation will be required)* Select YES NO

NAME(S) OF ANY BROTHERS OR SISTERS AT WELLINGTON SCHOOL

EMERGENCY CONTACTS (DAYTIME Telephone number)

PARENT/GUARDIAN 1

TITLE* Select Mr Mrs Ms Miss Dr

SURNAME*

FORENAME*

RELATIONSHIP TO PUPIL*

HOME ADDRESS*

POST CODE*

HOME TELEPHONE NUMBER*

MOBILE TELEPHONE NUMBER*

EMAIL ADDRESS - PLEASE NOTE THAT THIS EMAIL ADDRESS WILL BE USED FOR ALL COMMUNICATION*

PARENT/GUARDIAN 2

TITLE Select Mr Mrs Ms Miss Dr

SURNAME

FORENAME

RELATIONSHIP TO PUPIL

HOME ADDRESS

POST CODE

HOME TELEPHONE NUMBER

MOBILE TELEPHONE NUMBER

EMAIL ADDRESS

In the event of an emergency it is important that we have 2 further contact numbers which could be used during the school day if unable to contact Parent/Guardian

CONTACT 3

TITLE Select Mr Mrs Ms Miss

SURNAME

FORENAME

RELATIONSHIP TO PUPIL

HOME TELEPHONE NUMBER

MOBILE TELEPHONE NUMBER

CONTACT 4

TITLE Select Mr Mrs Ms Miss

SURNAME

FORENAME

RELATIONSHIP TO PUPIL

HOME TELEPHONE NUMBER

MOBILE TELEPHONE NUMBER

PUPIL IMAGES CONSENT

At Wellington School we often take photographs of pupils to celebrate success and publicise the school. We use these in the school’s prospectus, the school’s newsletter, on the school’s website, on the school's social media and on display boards in classrooms and around school. We would like your consent to take photos of your child and use them in the ways described above.

I GIVE MY CONSENT TO THE SCHOOL TAKING PHOTOGRAPHS OF MY CHILD TO BE USED IN THE WAYS DESCRIBED ABOVE* Select YES NO

If you change your mind at any time, you can let us know by emailing admin@wellington.trafford.sch.uk or calling school on 0161 928 4157.

MUSIC

Details of how to register for specialist tuition will be sent out at a later date

Does your child have instrumental or singing lessons? Select YES NO

If yes, please provide details and current standard

Does your child sing or play as part of an ensemble? Select YES NO

If yes, please provide details

SIGNATURE (PLEASE PRINT NAME)*

DATE*

If you have any queries, please email admissions@wellington,trafford.sch.uk

SECTION B

RELIGION

LANGUAGE SPOKEN AT HOME

FIRST LANGUAGE

COUNTRY OF BIRTH

NATIONALITY

ETHNIC GROUP: (A person’s ethnic group describes how they see themselves. This may be based on many things, including, for example, their skin colour, language, culture, ancestry or family history. ETHNIC GROUP IS NOT THE SAME AS NATIONALITY.)

Please select the appropriate box Select Any other Asian background Any other Black background Any other ethnic group Any other mixed background Any other White background Bangladeshi Black - African Black Caribbean Chinese Gypsy/Roma Indian Pakistani White - British White - Irish White and Asian White and Black African White and Black Carribean