Pupil Indemnity Form

The data you provide on this form will be used to update the School’s Management Information System and will be accessed by staff, where appropriate, to determine the correct course of action in situations involving your son or daughter. It is essential that this information is detailed and correct at the time of completion and it is the parents’ responsibility to update the school on any changes to the details provided on this form.

In accordance with the General Data Protection Regulation (GDPR) of May 2018, we hereby wish to notify you of how we intend to use the information you will provide on this form. The data we request on this form is deemed to be of either legal, vital or legitimate interest to the school. Your data will be kept in its entirety so long as your child is in attendance at the school. When your child leaves the school, some or all of your data may be kept dependent on various qualifying factors. Please see our Data Policy for more information on retention periods and how we use your data.

Section 1 - Pupil Information

Legal First Name:* Preferred First Name: Middle Name(s): Surname:* Date of Birth:* Gender:* Religion: Nationality:* Child's Address:*

Section 2 - Parent/Carer Details

Parent/Carer 1

Title:* First Name:* Surname:* Relationship to Pupil:*

Does this contact have the same address as the pupil?*YesNo

If no, please provide address: Mobile Number:* Home Number: Work Number: Email Address:*

Parent/Carer 2

Title:* First Name:* Surname:* Relationship to Pupil:*

Does this contact have the same address as the pupil?*YesNo

If no, please provide address: Mobile Number:* Home Number: Work Number: Email address:*

Are there any individuals who are not allowed to be given access to your child for legal, custodial or safeguarding reasons? If yes, please provide more information in writing.*YesNo

Section 3 - Emergency Contact Details

In the event of the school being unable to contact parent/guardians, please give contact details of at least two people who will act ‘in loco parentis.’ These contacts can also be used if your child is not collected from school when expected.

Emergency Contact 1

Title:* First Name:* Surname:* Relationship to Pupil:* Contact Telephone Number:*

Emergency Contact 2

Title:* First Name:* Surname:* Relationship to Pupil:* Contact Telephone Number:*

Section 4 - Medical Information

GP Practice Name and Address:* GP Telephone Number:*

Is your child currently seeing a doctor for an existing issue?*YesNo

If yes, please give details:

Have you any concerns regarding your child's hearing or vision?*YesNo

If yes, please give details:

If your child suffers from any ailments, recurring illnesses, diseases or other conditions please provide details below. Please note information about dietary requirements is in the following section.

Ailments/Conditions: Symptoms/Reactions: Medications:

Is medication to be kept in school?YesNo

If yes, please complete a medication form, also linked in the Welcome Pack, which will be stored with the medication. You will be fully responsible for ensuring the medicine provided to us is kept within use-by dates.

Section 5 - Dietary Requirements

Does this pupil have any Dietary Requirements?*YesNo

Please select all which apply:

Please specify if "other" chosen above: Please specify if "other" chosen above: Please specify if "other" chosen above:

Is your child prescribed medication in relation to allergies/intolerances?*YesNo

If yes, please complete a medication form, also linked in the Welcome Pack, which will be stored with the medication. You will be fully responsible for ensuring the medicine provided to us is kept within use-by dates.

Section 6 - Ethnic Categories and Language

It is a requirement of the Independent Schools Council (ISC) that we hold details of all our pupils’ ethnic origin. Since 1990 all maintained schools have been legally required to record the ethnic group of every pupil on entry to primary education and again on entry to secondary education. The categories used are consistent with those used by the DCSF. The table below has been taken from the Independent Schools Council annual census return. Please tick in the corresponding box next to your child’s ethnic category.

Please confirm your child's country of birth:* If born outside of UK, please confirm arrival date in UK: If your child attended a school abroad, please name the country, school and what year group/standard they were last in before joining the UK schooling system:

Is English your child's first language?*YesNo

Is English the language they are best/most fluent in?*YesNo

Please list any languages spoken at home: (Spoken by parents but not used to communicate with the child): Languages spoken to or by my child:

Section 7 - Travel Arrangements

All Greenfield pupils may travel in the school mini bus occasionally for class trips, sports matches and other events. We request that you give your consent for your child to travel in the minibus by ticking this box.

I give permission for my child to travel in the school minibus*YesNo

Section 8 - Image Consent

Before completing the following section, ensure you have read our Images of Children Policy. A copy is available on the school website.

I have read and understood the Images of Children Policy. I understand that the school may take photos/videos of my child for internal* uses*Yes

*Internal purposes include: identification on the school's MIS, internal display boards, all records kept for posterity including videos of performances, images shared on the school app, any other images documenting school life and work that are not shared with the outside community.

Please select one of the following*I DO give permission for my child’s image to be distributed subject to the Images of Children PolicyI DO NOT give permission for my child's image to be distributed subject to the Images of Children Policy

I understand that these permissions will be shared with third parties at events attended by my child.*Yes

I understand that these permissions will be adhered to after my child has left Greenfield, unless I issue further instruction.*Yes

Section 9 - Acceptable Conduct and Agreement

As a parent of a pupil at Greenfield School you are expected to adhere to a level of acceptable conduct when taking photographs or video footage of any Greenfield pupil. Please read and declare your co-operation below.

I understand that members of the school staff or Governing Body may question me or members of my extended family if they do not recognise us or if they feel that we are behaving inappropriately at a school event. Any photographs or video recordings taken at school events by myself, members of my family, or people under my employment (i.e. au pairs), are for family use only and they will not be shared on social media without prior consent.*Yes

It is the responsibility of the Parent/Guardian to keep us informed of any changes to the information on this form. We consent to the participation of our child in any off-site activities and residential trips, for which all Greenfield pupils are fully insured. We indemnify Greenfield staff, or those nominated by the school, against costs or expenses reasonably incurred by them on behalf of our child. In the event of the school being unable to contact a parent/carer with regard to an incident/accident either at school or during off-site and residential activities, we consent to the giving of urgent medical or surgical treatment to our child as may prove necessary. We undertake to inform the school office of any changes to the information contained in this form.

Signed (Name):*