Version 2.1
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
Version 2.1
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.
Version 2.1
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
Version 2.1
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: