School Pupil Data Capture Form (Primary)

Information on pupils and parents/carers is stored securely on a computer system. The information gathered is subject to the terms of the Data Protection Act 1998.

The information may be used for teaching, registration, assessment and other administrative duties. The information is shared with Moray Council for administrative and statistical purposes. Extracts of the information

are shared with a range of partners such as Skills Development Scotland, the Scottish Qualifications Authority, and the NHS (for the dental and child health immunisation programmes). Information is also shared with The

Scottish Government for statistical and research purposes, although individual children are not identified.

The Data Protection Act ensures that information is collected fairly and lawfully, is accurate, adequate, up to date, not held for longer than necessary, and may only be disclosed in accordance with the Codes of Practice.

For more information contact the Administrative Officer,

Education and Social Care, The Moray Council, Council Headquarters, Elgin, IV30 1BX.

I declare the information entered on this form to be correct and consent to the information being used for the purposes detailed above

Name of person completing this form

Signature Date

PLEASE COMPLETE IN BLOCK CAPITALS

PUPIL DETAILS Forenames Known As

(if different from forename)

Surname

Date of Birth Gender

Pupil Address

Postcode Home telephone number

Mobile telephone number Email Address

Scottish Candidate Number

Last School / Nursery Attended

Has the pupil ever attended a school in Scotland?

CONTACT INFORMATION: PARENTS / CARERS

Forename Surname

Title Gender

Address

(if different from pupil)

Postcode Daytime telephone number

Home telephone number Mobile telephone number Email address

Relationship

Notes

Can this parent / carer be contacted in the event of an emergency?

Forename Surname

Title Gender

Address

(if different from pupil)

Postcode Daytime telephone number

Home telephone number Mobile telephone number Email address

Relationship

Notes

Can this parent / carer be contacted in the event of an emergency?

CONTACT INFORMATION: ADDITIONAL PARENTAL CONTACTS

For the purposes of the school records, a pupil’s parent is defined as the pupil’s natural parent and any other person who is the pupil’s carer. Please add below anyone who comes into this category that has not been included in page 2.

Forename Surname

Title Gender

Address

(if different from pupil)

Postcode Daytime telephone number

Home telephone number Mobile telephone number Email address

Relationship

Notes

Can this parent / carer be contacted in the event of an emergency?

EMERGENCY CONTACTS

Forename Surname

Title Gender

Address

Postcode Daytime telephone number

Home telephone number Mobile telephone number Email address

Relationship

Notes

Forename Surname

MEDICAL INFORMATION Name of Doctor

Address of Doctor

Postcode Daytime telephone number

Allergies, Medical Conditions and Medication:

PERSONAL INFORMATION

Does the pupil have a disability?

If yes, what disability does the pupil have:

Has the pupil been assessed as having a disability?

If yes, who has assessed the pupil as having a disability:

Specific requirements or adaptations needed:

LANGUAGE INFORMATION Home language:

Please list all other languages spoken at home:

Does the pupil need support with English language: YES / NO

EQUALITY

Pupil Ethnic Origin

Pupil National Identity

01 – White – Scottish 01 – Scottish

21 – White – Other British 02 – English

22 – White – Irish 03 – Northern Irish

23 – White – Polish 04 – Welsh

09 – White – Other 05 – British

19 – White – Gypsy/Traveller 99 – Other

02 – African – African/Scottish/British 10 – Not Disclosed

25 – African – Other 98 – Not Known

03 – Caribbean or Black – Caribbean/British/Scottish Other:

24 – Caribbean or Black – Other

05 – Asian – Indian/British/Scottish

06 – Asian – Pakistani/British/Scottish

Pupil Asylum Status

07 – Asian – Bangladeshi/British/Scottish (please tick where appropriate) 08 – Asian – Chinese/British/Scottish Asylum Seeker

17 – Asian – Other Refugee

12 – Mixed or multiple ethnic groups 27 – Other – Arab

99 – Other – Other 10 – Not Disclosed 98 – Not Known Other:

Pupil Religion

Christian Hindu Jewish Muslim Sikh

Other Religion No Religion

Any other information about the child you would like the school to know?

PERMISSIONS

Media Filming, Photography & Recording

Opportunities arise from time to time for the press, television and radio to record events in educational establishments. Photographs of pupils (without names) may also appear in the school handbook and website.

In the main, this causes no difficulty for most parents but for some it can cause serious concern. This concern relates to the broad issue of Child Protection and the potential for identifying individual children. As a consequence of this situation the Head Teacher is required to seek consent for your child to be filmed, photographed or recorded by any media organisation which may use the material in a way which associates your child with this school. Circle ‘YES’ below to give permission for your child to be filmed, photographed or recorded by any media organisation. If you circle ‘NO’ your child’s name will be added to a confidential list issued to staff of pupils who can not appear in press photographs, etc.

I give permission for my child to be filmed, photographed or recorded by any media organisation YES / NO I give permission for my child to be included in photographs for the school handbook / website YES / NO or for other school publications

Internet and Email

I give permission form my child to be allowed access to email and Internet facilities in the school YES / NO in accordance with The Moray Council Guidelines on their use, and understand that any misuse

of these facilities will result in the withdrawal of this privilege

Declaration

I give permissions for my child as noted above

Signature Date