Admission Form - Additional Info

Please complete all fields marked (*)

Your first name *

Your last name *

Full name of child *

Your relationship to the child *

Does your child have any health condition or disability? *

If YES, please continue to answer the below questions. If NO, please skip the next three questions

Has it lasted or is it expected to last 12 months?

Does this have a substantial effect on your child's ability to carry out day to day activities?

Does your child take regular medication? *

Does your child regularly need to use an inhaler? *

Does your child have any allergies? *

Does/will your child have difficulty with...

Please read through the below statements and select yes/no

Moving about the school and going on school visits *

Use of hands and fingers (e.g. holding a pen/pencil) *

Lifting, carrying or moving objects (e.g. carrying school bag) *

Washing, going to the toilet, controlling the need to go to the toilet, dressing, etc *

Expressing themselves or understanding what others are saying *

School work including reading, writing, number work or understanding information *

Hearing or eyesight *

Making friends, relating to adults, behaving appropriately in school *

A medical need which has/is expected to last more than 12 months *

Complex health needs requiring daily assistance in order to maintain optimal health *

E.g. physiotherapy at school

Is there any other information you would like us to know about your child?

Please provide details if you need any support from school with communication

E.g. information sent in alternative formats (braille, large print)

Please provide a signature.

Tunbury Primary