External Sixth Form Admissions

Official Sensitive

Any information provided in this form will not affect the offer of a place. Any personal data entered on this form may be held on computer files.

Brentwood Academies Trust T/A St Martin’s School fully complies with information legislation.

For full details on how we use your personal information please see our online privacy notice https://www.st-martins.essex.sch.uk/privacynotice or call 01277 238303 if you are unable to gain access to the internet.

Student’s Legal Surname* Legal Forename* Middle Name(s) Date of Birth*

Gender*MaleFemale

Preferred Surname (if different) Preferred Forename (if different) Home Address* Post Code* Name and Address of Previous School* Mobile Number* Email Address - Personal*

Primary Contact

Title* Surname* Forename* Home Address (if different from above) Post Code (if different from above) Relationship to student (i.e. Mother, Father, Step Parent, Grandparent, Neighbour etc.)

Contact Details

Tel No* Mobile No Work No E-mail address*

Parental Responsibility*YesNo

Secondary Contact

Title Surname Forename Home Address (if different from above) Post Code (if different from above) Relationship to student (i.e. Mother, Father, Step Parent, Grandparent, Neighbour etc.)

Contact Details

Tel No Mobile No Work No E-mail address

Parental ResponsibilityYesNo

Parental Information

Are there any court orders in place that affects the student?*YesNo

Service Children in Education Indicator

Please indicate if the student has a parent or parents who are Service Personnel Category 1 or 2 serving in regular HM Forces military units of all forces or in the Armed Forces of another nation and stationed in England and is exercising parental care responsibility.*YesNo

Special Educational Needs (SEN) and Children in Care

Does the child have a statement of Special Educational Needs or an Education, Health and Care Plan?*YesNo

If yes please give details below

Is your child ‘Looked After’ by the Local Authority?*YesNo

If yes, please give the name of the Authority

Has this child ceased to be looked after due to Adoption, Residence Order or Special Guardianship Order?*YesNo

If yes, please give the name of the Authority

Medical Details

Name of doctor* Tel No* Surgery address* Does your child suffer from any illness or allergies or if taking any medication? Please let us know if there are any other medical issues you feel the school needs to be aware of.

Care plan needed? - If Yes, please provide relevant documentation*YesNo

Care plan:

Additional Information

I give permission for my child’s photo to be taken and used on the school website/press releases and twitter posts.*YesNo

I give permission for my child’s photo to be taken and used for internal use, for example, displayed in a classroom, alongside a piece of work, but not on social media or websites.*YesNo

I give permission for the named student to leave early after their last timetabled lesson*YesNo

Note:some students will find that their lessons may end earlier than a normal school day and students with parental permission are allowed to sign out and leave site early if they chose to do so

PARENTAL CONSENT: Parent/Carer’s Name* Date* Please give below names of any siblings currently attending St Martin’s

	Name	Form

If there is any additional information that you feel the school should be aware of, please upload the details below, for example: family circumstances, recent bereavements, individual needs (if you have given previous details with an older sibling please re-state these).*YesNo

Additional Information CONSENT OF PARENT OR PERSON WITH PARENTAL RESPONSIBILITY* Date*

Ethnic background information form

Student’s legal surname* Student’s forename(s)*

Gender*MaleFemale

Please study the list below and tick one box only to indicate the ethnic background of the child named above. Please also tick whether the form was filled in by a parent.

Asian or Asian BritishIndianPakistaniBangladeshiAny other Asian background

Any other ethnic backgroundChinese

MixedWhite and Black CaribbeanWhite and Black AfricanWhite and AsianAny other mixed background

Black or Black BritishCaribbeanAfricanAny other Black background

I do not wish an ethnic background category to be recorded

This information was provided by:*ParentStudent

First Language* Language Spoken at Home (if different from First Language)*

Please tick ONE of the following categories which you feel best describes the religion of your child

PARENTAL CONSENT: Parent/Carer’s Name*

(Any information you provide will be used solely to compile statistics on the school careers and experiences of pupils from different ethnic backgrounds, to help ensure that all pupils have the opportunity to fulfil their potential. These statistics will not allow individual pupils to be identified. From time to time the information will be passed on to the Local Authority and the Department for Children, Schools and Families (DCSF) to contribute to local and national statistics. The information will also be passed on to future schools, to save it having to be asked for again.)

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