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Horsham Academy Joining Form
Student's Full Name
Students Surname Name
Date of Birth
Main Stream Academy or Special Needs
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Parent-Guardian First Name
Parent-Guardian Surname Name
Parent-Guardian Email
Parent-Guardian Main Phone
Address Line 1
Address Line 2
Address Line 3
Town
Postcode
Emergency Contact Name
Emergency Contact Number
Emergency Contact Email
Relationship to child
2nd Emergency contact Number NOT the same as above.
Known Friends at Ariel
Medical conditions/allergies - please include instructions with regards to medication that may need to be administered. For allergies, please state what action should be taken in an emergency.
Medical Information
Has your child had any serious illness, operation or accident in the last year? If so, please give details.
Has your child had any illness during the past year? If so please give details.
Does your child have any difficulty with a) hearing or b) eyesight
Does your child require any medicines, or special treatment about which the Organisation should be informed? If yes, please give details with instructions/actions that need to be taken in the event of an incident.
Are there any other considerations Ariel should be made aware of? If yes, please give details with instructions/actions that need to be taken?
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