Athena College Application - Athena Sixth Form College

Details of Student

Legal name MUST be as it appears on the student's Birth Certificate

Legal Surname

Legal Forename

Legal Middle Name(s)

Preferred Surname

Preferred Forename

Date of Birth

Gender

Email Address

Address

Postcode

Home Telephone Number

Siblings attending Downham Market Academy or Athena Sixth Form College (if any)

Is Athena Sixth Form College your: (this will not affect your application in any way)

Firm choice Reserve choice Unsure

When you've submitted this form, we'll send a confirmation email to the email address provided above.

Course Preferences

Choice 1

Choice 2

Choice 3

Choice 4

Career intentions, including Higher Education (if known)

Predicted GCSE grades

Details of Parents/Carers with whom the Student lives

Parent / Carer 1

Title

Surname

Forename

Date of Birth

National Insurance (NI) Number

Relationship to Student

Parental Responsibility

YES NO

Mobile telephone number

Home telephone number

Email Address

Place of work

Work telephone number

Parent / Carer 2

Title

Forename

Surname

Date of Birth

National Insurance (NI) Number

Relationship to Student

Parental Responsibility

YES NO

Mobile telephone number

Home telephone number

Email Address

Place of work

Work telephone number

Please tell us immediately if any of the above details change

Separate Parent Information

For those with parental responsibility (but who may not necessarily reside with the child). In English law, Parental responsibility is a legal phrase used to define who has the rights and obligations in making decisions which affect the child's life. Parental responsibility includes legal rights and responsibilities in choosing and providing for the child's education. Unless there is a Protection Order from the Court, the College has a legal obligation to provide all people with parental responsibility, reports and school information. The College will assume that the person/s listed below, who has/have parental responsibility, but with whom the student does not reside, will automatically receive information regarding the pupil.

Protection Order Information

If there is a Protection Order issued against the person/s listed below, who have parental responsibility, please provide details on a separate piece of paper, to the attention of the College Designated Safeguarding Lead. The information you provide will be treated as strictly confidential but may be shared with other relevant members of staff at the discretion of the Designated Safeguarding Lead.

Has a Protection Order been issued?

YES NO

Title

Forename

Surname

Date of Birth

National Insurance (NI) Number

Relationship to Student

Parental Responsibility

YES NO

Address

Postcode

Home telephone number

Mobile telephone number

Email Address

Place of work

Work telephone number

Emergency Contact Details (other than Parents/Carers)

These are very important to us. If your child becomes ill during the day, we need to be able to contact you or someone acting for you who is able to collect your child. If we are unable to contact you, you may wish to give the contact details of up to two persons who may (with their agreement) act on your behalf in an emergency. If you have no relatives in the area, then ask a friend, neighbour or childminder if they would be willing to act as an emergency contact.

Contact Priority 1 (if parents/carers not available)

Title

Forename

Surname

Relationship to Student

Mobile telephone number

Home telephone number

Work telephone number

Contact Priority 2 (if parents/carers not available)

Title

Forename

Surname

Relationship to Student

Mobile telephone number

Home telephone number

Work telephone number

Lunch Arrangements

Lunch Choice

School Meal Free School Meal** Packed Lunch Special Dietary Requirements**

** Please provide details

The Education Funding Agency are committed to ensuring that those students who claim Free School Meals receive additional funding for their education so please do check your eligibility and claim if you are entitled to.

Please supply any further information (religious or cultural - e.g., food, dress, days of observance) which you feel may impact on your child's school life.

Medical Details

It is important that you provide us with information of the medical centre/surgery that your child is registered with.

Surgery Name and Address

Surgery Telephone Number

Emergency First Aid Consent

YES NO

Student's Medical Needs/Conditions

Allergies or intolerances (including food, medications or other substances)

Long term medical conditions

Short term medical conditions

Occasional medical conditions

Ongoing medical conditions

Please note that if your child has a long term, ongoing health needs they may require an Individual Health Care Plan (IHCP). The College will be in contact to arrange a suitable time to complete an IHCP with you.

It is helpful for the College to have copies of letters that diagnose conditions - please provide these in a sealed envelope for the attention of the SENCO at the College. Should your child suffer from any medical conditions that require them to take medication at school, this will be kept in a locked cupboard in our first-aid room. You need to provide us with the following:

Medication in its correct packet/container - blister packs for tablets are not acceptable.
Bottled medicine must be new and unopened, so we can monitor correct usage.
MUST have a dosage on the packet/bottle if an 'Over the counter medicine'
MUST have a prescription label if a prescription only medicine, with a valid 'from' date, expiry date, dosage and student's name on it. The label must be clear and not tampered with.
Written permission from the parent to administer the medication

Name of medication(s)

Dosage and frequency to be taken

It is the responsibility of the parent/carer to update the College of any changes to their child's medical needs

Special Education Needs (SEN)

Does your child have any Special Needs Provision

YES NO

If YES, please indicate below to confirm if your child is identified on the SEN register at their current school and if they have an Education and Health Care Plan (EHCP):

My child is on the SEN Register

YES NO

Does your Child have an EHCP?

YES NO

Please provide SEN/EHCP details

Ethnic Information

To help us and the local authority in monitoring equal opportunities you are asked to complete the following: Family's Ethnic Origin. (our ethnic background describes how we describe ourselves. This may be based on many things, including, for example, skin colour, culture, ancestry or family history. Ethnic background is not the same as nationality or country of birth.)

Ethnicity

National Identity

First Language

Other Language(s)

Religion

Does your child receive any additional English language support

YES NO

Travel Arrangements

Most used method of transport

If you believe your child may be entitled for free transport to Athena Sixth Form College, please refer to Norfolk County Council's web page.

Details of last school attended

A representative of Athena Sixth Form College will contact your child's previous school, prior to the starting with us to gather relevant information to ensure that transition is smooth.

Name of School

On what date did your child start at their current / last school

On what date did your child leave/due to leave their current/last school

Reason for leaving

If your child is not currently attending school, please tell us the date on which your child left their most recent school

Service Children in School

Schools are now required to indicate whether a child has parent(s)/guardian(s) currently serving in regular military units of any of the armed forces, and designated as Personnel Category 1 or 2.

Please could you indicate if your child is a 'service child in education' by selecting from the options

YES NO I do not wish a service indicator to be recorded

Children in care of a Local Authority

Is the child named above in the care of the local authority

YES NO

If yes, please name of Local Authority and provide details of the social worker currently assigned

Has the child ceased to be Looked After through adoption, a special guardianship order or a child arrangement order (formerly a residence order)? If so, please provide written evidence of this for the attention of the Data Assistant at the College

YES NO

Parent / Carer Consent

We require permission from you for several things. Please fill in the permission tick boxes below. In an instance of an organiser needing to contact you whilst your child is participating in a school trip the contact details used will be those recorded on the College database - it is therefore essential that any changes to contact telephone numbers are notified to the College as quickly as possible. Likewise, any medical conditions which your child may develop over their time at the College should also be reported to us.

Throughout my child's time at Athena Sixth Form College, I give the following permissions for my child:

Local Visits

Do you give permission for your child to be accompanied on a local visit without advance notice on the basis described?

YES NO

Name of Parent/Carer giving permission

Date

Use of Photograph/Video/DVD images

At Athena Sixth Form College we take the issues of child safety very seriously, and this includes the use of images of pupils.

Throughout my child's time at Athena Sixth Form College, permission is given for my child to be photographed and those images used in the following places:

In Athena Sixth Form College / Downham Market Academy Publications On the Athena Sixth Form College / Downham Market Academy Website By the local press By the local press but I prefer their name not to appear alongside the image Decline All

Name of Parent/Carer giving permission

Date

Biometric Data

Athena Sixth Form College operates a Cashless catering service. New students will be enrolled onto the system upon joining the College.

The method of recognition which Athena Sixth Form College has chosen is Thumbprint scanning. This system does not store any personal identity data on the system. When purchasing food from the canteen, your child will simply place their thumb on the reader when they arrive at the till.

Students whose parents/carers do not consent to the use of biometric data will still have a cashless catering account but this will be access manually by the till operators entering the student's name - operating accounts in this way means that transactions will take longer and also carries a higher risk of administrative error, whereby incorrect accounts could be inadvertently debited.

Do you give permission for the College to use biometric data for your child, as described?

YES NO

Name of Parent/Carer giving permission

Date

Declaration

I certify that, to the best of my knowledge, the information on this form is correct

YES NO

Digital Signature (please type your name)

Relationship to Child

Date

Data Protection

I consent to providing this information to the College. It will be processed in accordance with the Trust Privacy Policy.

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Details of Student

Course Preferences

Details of Parents/Carers with whom the Student lives

Separate Parent Information

Protection Order Information

Emergency Contact Details (other than Parents/Carers)

Lunch Arrangements

Medical Details

Student's Medical Needs/Conditions

Please note that if your child has a long term, ongoing health needs they may require an Individual Health Care Plan (IHCP). The College will be in contact to arrange a suitable time to complete an IHCP with you.

Special Education Needs (SEN)

Ethnic Information

Travel Arrangements

Details of last school attended

Service Children in School

Children in care of a Local Authority

Parent / Carer Consent

Local Visits

Use of Photograph/Video/DVD images

Biometric Data

Declaration

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