School Pupil Data Capture Form (Primary)

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1 Information on pupils and parents/carers is stored securely on a computer system. The information gathered is subject to the terms of the Data Protection Act The information may be used for teaching, registration, assessment and other administrative duties. The information is shared with Moray Council for administrative and statistical purposes. Extracts of the information are shared with a range of partners such as Skills Development Scotland, the Scottish Qualifications Authority, and the NHS (for the dental and child health immunisation programmes). Information is also shared with The Scottish Government for statistical and research purposes, although individual children are not identified. The Data Protection Act ensures that information is collected fairly and lawfully, is accurate, adequate, up to date, not held for longer than necessary, and may only be disclosed in accordance with the Codes of Practice. For more information contact the Administrative Officer, Education and Social Care, The Moray Council, Council Headquarters, Elgin, IV30 1BX. I declare the information entered on this form to be correct and consent to the information being used for the purposes detailed above Name of person completing this form Signature Date PUPIL DETAILS PLEASE COMPLETE IN BLOCK CAPITALS s Known As (if different from forename) Date of Birth Pupil Postcode Scottish Candidate Number (if known) Last School / Nursery Attended (please enter school name, address and telephone number) Has the pupil ever attended a school in Scotland? (please enter school name and address) Please list any siblings that the pupil has: Name of sibling Relationship (for example, brother / sister) School / Pre-School Attended SEEMIS Pupil

2 CONTACT INFORMATION: PARENTS / CARERS (if different from pupil) Relationship (e.g. mother, father) (e.g. can not be contacted at work) Can this parent / carer be contacted in the event of an emergency? (yes or no) (if different from pupil) Relationship (e.g. mother, father) (e.g. can not be contacted at work) Can this parent / carer be contacted in the event of an emergency? (yes or no) SEEMIS Pupil

3 CONTACT INFORMATION: ADDITIONAL PARENTAL CONTACTS For the purposes of the school records, a pupil s parent is defined as the pupil s natural parent and any other person who is the pupil s carer. Please add below anyone who comes into this category that has not been included in page 2. (if different from pupil) Relationship (e.g. mother, father, grandparent) Can this parent / carer be contacted in the event of an emergency? (yes or no) EMERGENCY CONTACTS (in the event that a parent / carer can not be contacted) Relationship (e.g. grandparent, neighbour) Relationship (e.g. grandparent, neighbour) SEEMIS Pupil

4 MEDICAL INFORMATION Name of Doctor of Doctor Allergies, Medical Conditions and Medication: PERSONAL INFORMATION Does the pupil have a disability? (yes or no) If yes, what disability does the pupil have: Has the pupil been assessed as having a disability? (yes or no) If yes, who has assessed the pupil as having a disability: Specific requirements or adaptations needed: LANGUAGE INFORMATION Home language: Please list all other languages spoken at home: Does the pupil need support with English language: YES / NO SEEMIS Pupil

5 EQUALITY Pupil Ethnic Origin (please tick one category) Pupil National Identity (please tick one) 01 White Scottish 01 Scottish 21 White Other British 02 English 22 White Irish 03 Northern Irish 23 White Polish 04 Welsh 09 White Other 05 British 19 White Gypsy/Traveller 99 Other 02 African African/Scottish/British 10 Not Disclosed 25 African Other 98 Not Known 03 Caribbean or Black Caribbean/British/Scottish Other: 24 Caribbean or Black Other 05 Asian Indian/British/Scottish 06 Asian Pakistani/British/Scottish Pupil Asylum Status 07 Asian Bangladeshi/British/Scottish (please tick where appropriate) 08 Asian Chinese/British/Scottish Asylum Seeker 17 Asian Other Refugee 12 Mixed or multiple ethnic groups 27 Other Arab 99 Other Other 10 Not Disclosed 98 Not Known Other: Pupil Religion (please tick one category) Buddhist Christian Hindu Jewish Muslim Sikh Other Religion No Religion Any other information about the child you would like the school to know? SEEMIS Pupil

6 PERMISSIONS Media Filming, Photography & Recording Opportunities arise from time to time for the press, television and radio to record events in educational establishments. Photographs of pupils (without names) may also appear in the school handbook and website. In the main, this causes no difficulty for most parents but for some it can cause serious concern. This concern relates to the broad issue of Child Protection and the potential for identifying individual children. As a consequence of this situation the Head Teacher is required to seek consent for your child to be filmed, photographed or recorded by any media organisation which may use the material in a way which associates your child with this school. Circle YES below to give permission for your child to be filmed, photographed or recorded by any media organisation. If you circle NO your child s name will be added to a confidential list issued to staff of pupils who can not appear in press photographs, etc. I give permission for my child to be filmed, photographed or recorded by any media organisation YES / NO I give permission for my child to be included in photographs for the school handbook / website or for other school publications YES / NO Internet and I give permission form my child to be allowed access to and Internet facilities in the school YES / NO in accordance with The Moray Council Guidelines on their use, and understand that any misuse of these facilities will result in the withdrawal of this privilege Declaration I give permissions for my child as noted above Signature Date SEEMIS Pupil

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