Data Collection Form 1. PUPIL INFORMATION FIRST NAME * MIDDLE NAME (if any) LAST NAME * PREFERRED NAME (if any) GENDER * Girl Boy DATE OF BIRTH * Home Address (including postcode) YEAR GROUP/CLASS * NurseryReceptionYear 1Year 2Year 3Year 4Year 5Year 6 DID YOUR CHILD ATTEND SPRING GROVE NURSERY? * Yes No 2. CONTACT DETAILS We will use this information as your main contact details. MAIN CONTACT NUMBER * MAIN E-MAIL * 3. FAMILY CONTACT DETAILS 3.1 PARENT/CARER RELATIOSHIP TO THE CHILD * MotherFatherStep ParentGuardianOther Family Member (siblings,relative)Other RELATIOSHIP TO THE CHILD NAME * E-MAIL * MAIN CONTACT NUMBER * ADDITIONAL NUMBER(S) Address if different from Section 1(including postcode) 3.2 PARENT/CARER RELATIONSHIP TO THE CHILD * MotherFatherStep ParentGuardianOther Family Member (siblings,relatives)Other RELATIONSHIP TO THE CHILD NAME * E-MAIL * MAIN CONTACT NUMBER * ADDITIONAL NUMBER(S) Address if different from Section 1(including postcode) 3.3 EMERGENCY CONTACT We must have a third emergency contact, it must be someone other than the persons listed above. NAME * CONTACT NUMBER * RELATIONSHIP TO THE CHILD * Step ParentOther Family Member (siblings,relatives)Other RELATIONSHIP TO THE CHILD ADDITIONAL NUMBER(S) 4. SIBLINGS AT SPRING GROVE Does your child have any siblings at Spring Grove? * Yes No – Go to Section 5 Sibling details Sibling Name * Class (Current) * ReceptionYear 1Year 2Year 3 – AppleYear 3 – LimeYear 4Year 5Year 6 plus1 Add minus1 Remove If you are human, leave this field blank. Next Δ
