Data Collection Form

Please complete the details below.

1. Preferred Surname: *

2. Legal Surname (if different):

3. Legal Forename: *

4. Middle Name: *

5. Preferred Forename: *

6. Date of birth: *

YYYY

7. Gender: *

Male

Female

8. Brother/Sister in school: *

Yes

9. Name(s) of Brother/Sister(s): *

10. Address (Must include House Name or Number): *

11. Post code: *

Emergency Contacts:

Please give details of all persons who have parental responsibility and anyone else you wish to be contacted in an emergency. Place them in the order that you wish for them to be contacted.

1st contact

12. Parent/Guardian: Relationship to Pupil (e.g parent, step parent): *

13. Surname: *

14. Forename: *

15. Title: *

Mrs

16. Address: *

17. Postcode: *

18. Home telephone: *

19. Email: *

20. Work telephone: *

21. Mobile number: *

2nd contact

22. Parent/Guardian - Relationship to Pupil (e.g Parent/Step parent) *

23. Surname: *

24. Forename: *

25. Title: *

Mrs

26. Address: *

27. Postcode: *

28. Home telephone: *

29. Email: *

30. Work telephone: *

31. Mobile: *

3rd contact

32. Other Contact: Relationship to Pupil (e.g grandparent, Childminder): *

33. Surname: *

34. Forename: *

35. Title: *

Mrs

36. Address: *

37. Postcode: *

38. Home telephone: *

39. Email: *

40. Work telephone: *

41. Mobile number: *

42. Mobile number for texting service: *

43. Email address for Seesaw: *

44. Eligible for Free Meals (apply online at www.eani.org.uk/financial-help/free-school-meals): *

Yes

45. Medical Practice: *

46. Telephone: *

47. Address of Medical Practice: *

48. Medical Information: *

49. Special Dietary Needs: *

50. Previously Registered with a Sure Start project: *

Yes

Do not know

51. Attended a Sure Start Programme for 2-3 Year Olds: *

Yes

Do not know

52. Travel Arrangements: *

Bicycle

Train

Walks

Car

Taxi

School Coach

Public Transport

53. Has this child been Baptised in the Roman Catholic Religion?: *

Yes

If baptised outside Magherafelt Parish, please give place of Baptism - and Baptism Certificate must be presented to the School.

Please note: A pupil cannot receive the Sacraments of the Eucharist and Confirmation unless the school has a copy of the child's Baptism Certificate.

54. Place of Baptism: *

55. Previous School/Pre School: *

56. Date of Admission: *

YYYY

57. Reason for Leaving: *

58. Date of Leaving: *

YYYY

Data Protection Act 1998: The school is registered under the Data Protection Act for holding person data. The school has a duty to protect this information and to keep it up to date., The school is required to share some of the data with the Education Authority and with the Department of Education.

59. Religion: *

60. Ethnicity: *

61. Nationality *

62. Home Language: *

63. Do you need a translator for Parent/Teacher Meetings? *

Yes

64. Parent/Guardian Signature - Print name: *

65. Date: *

YYYY

66. Please confirm that you have read and agreed to the Policies (available on the website): *

Yes, I have read them

Special Educational Needs & Disability

68. Please describe any special educational needs and/or disability that your child has. *

69. Please comment on anything that might affect your child's learning and/or safety: *

70. Please indicate if you would like to discuss this further with the SENCO: *

Yes

71. Please indicate your permission for us to seek information relating to your child's special education needs and/or disability from the agencies of professionals listed above. *

Yes

Parental Permission And Parental Agreement

Section A: Holy Family PS Parental Permission

72. ADMINISTRATION OF MEDICATION

The school would prefer not to administer prescribed medications unless it is absolutely necessary. In the event that a child needs prescribed medicine during the school day please send in a signed note to the class teacher. These medicines will be kept in a secure location where they are out of reach of other children. It is the responsibility of the parents / guardians to ensure all medicines provided are clearly labelled with child’s name, class, dosage and times to be administered and within the expiry date.

I can confirm I have read the above information and I am aware of the procedures required. TICK BOX

73. USE OF MOBILE PHONES

Pupils are not permitted to bring Mobile Phones to school. If they need to make a phonecall they may chat with their class teacher or member of Senior Management and they will organise for a phone call to be made via the School Office.

Where a pupil is found by a member of staff to be using a mobile phone/tablet during the school day, the phone/tablet may be taken from the pupil and handed to a member of the school’s Senior Leadership Team (SLT). The mobile phone/tablet will be stored in the school office until the end of the school day. The pupil may collect the phone/tablet at the end of the school day and the child’s parent/guardian will be contacted.

I can confirm I have read the above information and I am aware and my child is aware he/she is not permitted to bring a mobile phone to school. TICK BOX

74. ADMINISTRATION OF PLASTERS

From time to time, children may require a plaster to be administered onto minor cuts/grazes/ Please confirm that you give permission to staff, to administer plasters if required. Please also advise the school in writing if your child has or develops an allergy to plasters during the school year.

I can confirm I give permission for class teacher or an additional staff member to apply plasters to my child/children if required. TICK BOX

75. HAND SANITISER

I can confirm I give permission for my child/children to use hand sanitiser provided in school. TICK BOX

76. TOILETING AND INTIMATE CARE

In Holy family P.S., children are encouraged to become completely independent in their personal care and toileting needs. Generally, children are free to use toilets as they need during the day. However, occasions may arise when a child may require support with their personal care as a consequence of an ‘accident / incident’. On such occasions, designated members of staff will be available to arrange for the child to get an appropriate change of clothing.

Volunteers or students will not be asked to offer such care, unless in an extreme emergency.

If your child has an ‘accident/incident’, a designated member of staff will: -

Console the child and provide him/her with a change of clothes from the school supply.
Escort the child to a changing area, and if required, assist in cleaning the child and/or his/her clothes.
The bag of soiled clothing is to be collected by parent/carer, and washed at home.
The child’s parent/carer will be informed of the ‘accident/incident’ as soon as possible.
If a child resists the care being offered by a designated member of staff, the parent/carer will be contacted and no further action taken until their arrival.
If a child is having toileting ‘accidents/incidents’ frequently, the teacher will meet the parent to discuss and plan appropriate action.

If you are acceptant of this protocol as outlined above, please tick the consent statement below to enable staff to take appropriate action. If there are any specific issues relating to your child, please feel free to contact their teacher and update them in confidence.

Please note when contact cannot be established with the parent/carer, the school reserves the right to use its own discretion.

I understand the procedures outlined above by Holy Family PS with regard to the personal care and toileting needs of my child. I agree to action being taken, if necessary, as outlined in the protocol above. TICK BOX

77. VISITS OUT OF SCHOOL

From time to time it may be necessary for your child to leave the school grounds under staff supervision and to take part in organised school trips and events throughout the school year. This may include Educational trips, Sporting Events, Shared Education lessons, Credit Union visits, visits to Library, other schools, our local church, local shops, GAA club etc.

I can confirm I give consent for my child/children to take part in organised school trips throughout the school year and leave the school grounds under staff supervision. TICK BOX

78. PARENT ICT PERMISSION

As Parent/Guardian I have read the Acceptable Use of the Internet: Guidelines for Pupils and Parents. I understand that this access is for educational purposes. I recognise that it is impossible to restrict access to all controversial materials and I will not hold Holy Family PS responsible for any improper or illegal use of the internet in school by my child/children. Additionally, I accept full responsibility for supervision if and when my child/children is not in a school setting. I hereby give permission to permit internet access for my child/children and certify that the information contained on this form is correct.

I have read the above and allow for internet access for my child/children and certify and that the information is correct. TICK BOX

PHOTOGRAPHS / VIDEOS / PUPIL WORK

Please read the following statements and respond by ticking Yes or No

79.

SCHOOL DISPLAY BOARDS

I give permission for photographs, voice recordings or videos of my child/children to be taken and used on display boards around the school and in community displays.

Yes

80.

SCHOOL NEWSLETTER

I give permission for photographs of my child/children to be used in the printed school newsletter. I understand that it is posted on the school website.

Yes

81. I give permission for my child/children to be named in the caption or article associated with the image in the school newsletter.

Yes

82.

SCHOOL WEBSITE AND SOCIAL MEDIA

I give permission for photographs, voice recordings or videos of my child/children to be used on the school website.

Yes

83. I give permission for my child’s/children’s work to be shared on the school website or school-managed social media portals e.g. Facebook, Twitter and Seesaw.

Yes

84.

PROMOTIONAL MATERIAL

I give permission for my child’s/children’s image, voice or work may be used in school promotional materials. (For example: prospectus, other publications that we produce for promotional purposes)

Yes

85.

MEDIA

I give permission for visiting media organisations to take photographs or video footage of my child/children and use them in local or national publications, on websites and on radio or television programmes.

Yes

Section B: Holy Family PS Parental Agreement

86.

I can confirm that I have read and I agree to comply with the school policies and procedures linked to Safeguarding and Child Protection listed below.

Handling Complaints Policy
Safeguarding and Child Protection Policy
Acceptable Use of the Internet: Guidelines for Pupils and Parents
Data Protection Statement
Positive Behaviour Policy

I can confirm that I am aware that all policies are available on the school website: (www.holyfamilyps.com) and can be obtained on request from the school office. I agree to comply with all school policies and procedures.

87. I consent for information contained in my child’s/children’s data capture form to be retained and used by the school as outlined above in the school Privacy Notice and Data Statement which is published on the school website and available from the school office on request.

TICK BOX

88. Safeguarding Team & Board of Governors Safeguarding Team
I can confirm that I am aware of the School Safeguarding Team & Governors Safeguarding Team (on display at the front reception area and on school website).

TICK BOX

Section C: SeeSaw Information for Pupils and Parents

Guidelines for Parents/Guardians using Seesaw.

At Holy Family Primary School we pride ourselves on ensuring excellent communication between home and school. As part of this, we will be using Seesaw as a communication tool and also as a medium for home learning and homework.

Under GDPR if you sign up to Seesaw you give your consent for your child/children to use Seesaw. No information will be shared with any outside organisations. Further information is available on the Seesaw website.

The school have made the children aware of the Seesaw guidelines for children, agreed by all children and staff. Children are regularly reminded of these guidelines.

We have also developed a number of guidelines for parents.

Talk to your child/children about appropriate icons and images to use for their profile picture. The school recommends children use a profile photo of their face, a family pet or their initials.

Parents may send a message to the class teacher via Seesaw, however, we would ask that no messages are sent via Seesaw during the school day as the class teachers are teaching throughout the day and may not see any message sent via Seesaw.

Holy Family PS staff will endeavour to respond to any messages sent through Seesaw between 3-4pm each day.

Parents SHOULD NOT screenshot or share any information on social media or any other platform outside of Seesaw.

Parents SHOULD NOT send any photos or images of their child/children/family members.
Teachers will not use Seesaw after 4pm each day during normal teaching days. Any work uploaded after this time will be marked the next day.

Guidelines for children using Seesaw.

If interacting with other pupils or staff online, pupils should always be kind and respectful to each other and respectful and obedient to staff, remembering at all times that staff are not ‘friends’ with, or peers to, pupils.

Pupils should never attempt to contact staff via social media or make comments about staff on social media platforms. Any inappropriate comments to staff online or any other platform will be taken very seriously. This is also the case for any online bullying towards other pupils that is disclosed to the school during this time.

Guidelines for children using Seesaw.

Post your work in a responsible and sensible manner.

Don’t tag any other pupils in your work.

Do not change your name or any of your details which have been set up by your teachers.

Your profile picture can only be your initials, a screenshot of only your face or a pet.

Tell an adult straight away if you have any problems with the app.

Do not give your sign up details to anyone except for parents/carers.

Only post up pictures of your homework sheets or Seesaw Activities.

Pupils SHOULD NOT send any photos or images of?themselves or family members.?Please do it in a room with your parents/carers present.

Show your homework to your parents/carers before you send it to your teachers.

Content on Seesaw should not be shared on any other apps or on social media.

Anything that is done which doesn’t follow the guidelines above will result in parents/ carers being contacted.

89. I can confirm that I have read and I agree to comply with the school procedures and guidelines for pupils and parents linked to the home learning platform ‘Seesaw'.
Parent/Guardian, please sign below:

Website