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Gullane Primary School Muirfield Terrace Gullane EH31 2HL

1) The information provided by you is processed electronically & stored by East Lothian Council for admin purposes in

accordance with the Data Protection Act 1998. You have the right to see & access this information at any time. Extracts of this

information will be shared with the Scottish Government & East Lothian Council’s Education & Childrens’ Services annually,

exclusively for research & analysis purposes; whereby individual children will not be identified. Extracts of this information will

also be shared with the Electoral Registration Officer to offer the opportunity to register on the Electoral Roll when approaching

their 18th birthday; and with the NHS for monitoring the child health immunisation programme. For those of you who will leave

school in the next few years, East Lothian Council will need to hold & share information about you in order to support you in the

period after you leave school & provide career planning services. This will consist of your name, address & school results, but

may also contain sensitive personal data, e.g. information about your health or any convictions. To help with your career choices,

your information may be shared with: East Lothian Council Services, SDS (Careers Scotland), Colleges or Universities, National

Training Providers & relevant Voluntary Organisations. The uses of the information are covered by the Council’s registration

under the Data Protection Act 1998.

2) Changes of circumstances must be notified in writing to the school immediately.

3) Please complete all sections, sign and return to the school.

PLEASE COMPLETE IN BLOCK CAPITALS

Forenames Please underline the name by which the pupil is usually known.

Surname

*Date of Birth

Please give figures; e.g. 14 6 1984

*Sex (M/F)

Names of brothers and sisters already at this school (if any)

Pupil’s home address

*Postcode

Home Tel No

Parents / Guardians living at pupil’s home address

Relationship to pupil

Title

Forenames

Surname

If able to be contacted during the day in an emergency please give whereabouts eg home, workplace give whereabouts

e.g. Father e.g. Mother

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Daytime Tel No

Mobile Tel No.

Email Address

Name of Pupil: Class:

Letters will be addressed to the parents / guardians named above using the pupil’s address. If this is not appropriate, please write the alternative here.

Other emergency contacts (excluding parents / guardians)

Give names, daytime telephone numbers & relationship to pupil (e.g. neighbour, aunt, grandparent or friend)

Previous School

Medical Details

Doctor’s name Tel. No

Address

Parents may convey relevant medical information here or under separate cover to the school. The information is processed electronically but in coded form to enable staff to respond to pupils’ needs.

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Name of Pupil: Class:

Does the pupil consider themselves to have a disability? Yes

No

If so, please provide details:

To help the NHS plan and conduct large scale programs such as immunisations, vision screening and dental checks, pupil data is securely sent to the NHS. This data consists of details such as name, date of birth, gender and postcode. If you do NOT wish this data to be sent to the NHS for these purposes, please tick this box:

Additional parental contacts For the purposes of the school records, a pupil’s parent is defined as his/her natural parent and any other person who is

his/her guardian, who has custody of, or who is likely to maintain, him/her. Please add below anyone who comes into this category but who is not included on a separate sheet.

Relationship to pupil

(e.g. Mother, Father or Grandparent)

Title

Forenames

Surname Can be contacted in an emergency during the day

Yes

No

Yes

No

(please tick)

If yes, give whereabouts (e.g. at home or name of workplace)

Daytime Tel. No

Address

Postcode

Home Tel. No

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Pupils Name

We would like to collect information we hold about your language, religion, ethnic background and national identity. Could you please circle the category that you or your family felt best describes you. 1 FIRST LANGUAGE USED IN THE HOME

Arabic Bengali Cantonese English French Gaelic (Scottish)

German Polish Punjabi Scots Urdu

Other language (Please specify). . . . . . . . . . . . . . Parent/Guardian does not wish to disclose this information . . . . . . . . . . . . .

2 OTHER LANGUAGES USED IN THE HOME

Arabic Bengali Cantonese English French Gaelic (Scottish)

German Polish Punjabi Scots Urdu

Other language (Please specify). . . . . . . . . . . . . . Parent/Guardian does not wish to disclose this information . . . . . . . . . . . . . 3 RELIGION OF PUPIL

Buddhist Christian Hindu Jewish Muslim None

Sikh

Other religion (Please specify) . . . . . . . . . . . . . . Parent/Guardian does not wish to disclose this information . . . . . . . . . . . . . 4 ETHNIC ORIGIN OF PUPIL

White - Scottish White - Other British White - Irish White - Gypsy / Traveller

White - Polish

Mixed or multiple ethnic groups

Asian - Indian / British / Scottish

Asian - Pakistani / British / Scottish

Asian - Bangladeshi / British / Scottish

Asian - Chinese / British / Scottish

Caribbean or Black - Caribbean / British / Scottish

Caribbean or Black - Other

African - African / British / Scottish

African - Other Other - Arab

Other ethnic background (Please specify) . . . . . . . . . . . . . . Parent/Guardian does not wish to disclose this information . . . . . . . . . . . . . 5 NATIONAL IDENTITY OF PUPIL British English Northern Irish Scottish Welsh

Other national identity (Please specify) …………………………………. Parent/Guardian does not wish to disclose this information . . . . . . . . . . . . . 6 ASYLUM STATUS OF PUPIL (if appropriate)

Asylum Seeker Refugee

Parent's/Guardian's signature (if required) Date

For Office Use only Admission Date: