Registration Form This registration form is part of the school’s legal requirements relating to Child Protection, Safeguarding and, Health and Safety. Please complete all fields. 1. Student Surname House No. & Rd First Name Area Date of birth City Place of birth Postcode 2. Parent, Guardians Mother Surname Name Tel Email Father Surname Name Tel Email 3. Alternative Contact Surname Tel First Name 4. English School School Year (current) Head Teacher Tel 5. Medical Information Practice Doctor Tel Other information of which the school should be aware (e.g. allergies etc) 6. I agree to (V)... My child taking part in Religious Education lessons. Publishing photographs of my child on the Derby Polish Supplementary School website. Publishing photographs of my child on the Derby Polish Supplementary School Facebook page. My child receiving treatment including medication from qualified medical staff. By signing and submitting, Parents/ Guardians accept the terms and conditions of Derby Polish Supplementary School and confirm that the information given in this form is correct. Signature Date 7. School correspondence We send all important messages, letters and school correspondence to your e-mail address E-mail
