Lightcliffe Academy Admission Form

Student Admission Form

Welcome to Lightcliffe Academy

Please read the Information Pack carefully before completing the Admission Form

By completing your name, you are signing this Admission Form electronically and agreeing to any consent requested below
Student Details
Legal Name *
Preferred Name
Date of Birth *

Day Month Year
Gender *

Male Female Other option

Address *

Street Address
Street Address Line 2
Town	County
Postcode	Country

Date of Admission *

/ Day / Month Year
Date
Previous School *
Other School
Please state if not listed above
Siblings in School (if any)
Year and Form

Parents or Carers who have legal responsibility to the child
1. Parent/Carer *

Title
Relationship to child *
Parent serves in the Armed Forces *

Yes No

Address (if different to child)

Street Address
Street Address Line 2
Town	County
Postcode	Country

2. Parent/Carer

Title
Relationship to child
Parent serves in the Armed Forces

Yes No

Address (if different to child)

Street Address
Street Address Line 2
Town	County
Postcode	Country

Parent/Carer living at an address different to the child who wishes to receive:
Please select appropriate

Student Report Text Messages Other Correspondence
Relationship to child

Emergency Contact Information

Please note that the Academy Text Messaging Service uses the primary number of the first contact
First Contact *

Title
Relationship to child *
Home Number
Mobile Number
Work/Other
Email
Second Contact

Title
Relationship to child
Home Number
Mobile Number
Work/Other
Email
Third Contact

Title
Relationship to child
Home Number
Mobile Number
Work/Other
Email
Fourth Name

Title
Relationship to child
Home Number
Mobile Number
Work/Other
Email

Ethnic/Cultural Background:

(Based on the national population Census ethnic categories)
Our ethnic background describes how we think of ourselves. This may be based on many things, including, for example, our skin colour, language, culture, ancestry or family history.
Ethnic background is not the same as nationality or country of birth.

The Information Commissioner (formerly the Data Protection Register) recommends that young people over 11 years old have the opportunity to decide their own ethnic identity. Parents of those with parental responsibility are asked to support or advise those children aged over 11 in making this decision, wherever necessary. Students 16 or over can make this decision for themselves.

Please select an ethnicity below to indicate the ethnic background of the student or child named above. Please also sign to indicate whether the form was filled in by a Parent/Carer or the child.
Ethnicity *
Country of Birth *
Nationality *
Home Religion *
Home Language *
First Language *
English as Additional Language *
If yes, please state Proficiency in English below
Proficiency in English Language
This information was provided by:
Ethnic/Cultural Background - Parent/Carer E-Signature

Clear
Or Ethnic/Cultural Background - Student E-Signature

Clear
Any information you provide will be used solely to compile statistics on the school careers and experiences of students from different ethnic backgrounds, to help ensure that all students have the opportunity to fulfil their potential. These statistics will not allow individual students to be identified. From time to time the information will be passed to the Local Education Authority and the Department for Education and Skills (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.

Parent/Carer Permission for Photographs/Video

As a safeguarding measure all students will be photographed on entry into the academy for Cashless Catering and an Identity Badge.

Periodically students may be photographed, recorded on video or asked if their photographs etc. may either be published in the press or used on the academy website. If the students are following some GCSE courses it may also be necessary to video them as part of the evidence for the examination. The Academy is advised that it should seek the permission of Parents/Carers for this to occur. Therefore could you please complete the information below to indicate whether you are prepared to allow photographs or videos to be taken of your son/daughter, which may be either used in the Academy or released to the press to celebrate the success of the student.

Yours sincerely
Carol Kitson
CEO/Executive Principal
I hereby give permission for photographs/videos, in which the below named student may appear, to be stored for examination purposes, released to the press, or used on the Academy’s website to celebrate their academic/sporting success.
Photographs/Video - Parent/Carer E-Signature:

Clear

Parent/Carer Consent for Fixtures and Sporting Events

During your child’s time at Lightcliffe Academy, they may be asked to participate in off-site sporting events, fixtures, competitions or performances.

In order for Lightcliffe Academy to ensure the health and safety of your child whilst taking part in Sporting Events, we ask that you complete the below information to cover the duration of your child’s time at Lightcliffe Academy.

Without this consent, your child will not be able to participate in any of these off site activities.
I agree that:
- Can participate in sporting events and off-site physical activities whilst at Lightcliffe Academy and I understand they will be issued with full details prior to every fixture/event
- Can be transported in the school minibus or private coach if necessary
- Is in good health and fit to participate in the activities described
- Can receive First Aid treatment if required
I will ensure that if any of the information given changes i.e. contacts/medical conditions, I will inform the school.

I acknowledge the need for the student named above to behave responsibly and agree to the Academy’s procedures in this regard.
Fixtures/Sporting Events - Parent/Carer E-Signature:

Clear

Please use this space to add any additional information about you and your child.
Please add an email address if you require a submission confirmation
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Submitter name *
Enter the text as shown below *
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Student Details

Parents or Carers who have legal responsibility to the child

Emergency Contact Information

Medical Information

Ethnic/Cultural Background: