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Confidential Disclosures Form (Pre-Visit Information)

Please complete the form below for Lady Barn House School in advance of your child's visit. This form is relevant for taster days, test days and observational visits to the Early Years.

Completion of the form will allow us to ensure that we have everything in place to ensure your child's safety and wellbeing during their visit.

It will be necessary for parents to update the School on any matters as soon as possible as their child moves through the application process and then during their time at the School.

If your child uses any medication on a regular basis, this will need to be brought to school on the day of the visit and handed to the School Nurses - this might include inhalers or an EpiPen.

Pupil Details

Forename(s) *

Preferred Name *

Surname *

Gender *

Date of Birth *

Year of Entry e.g. Prep 5 (Year 5) September 2023 or Prep 3 immediate start *

Present School or Nursery Details

Name of School or Nursery setting *

Post Code of setting

Contact Number of setting *

Contact Name

Please attach a copy of your child's most recent school/nursery report, if you have one.

List of Allowed file types

For children seeking to join Reception and above - References from a pupil's current nursery or school are an important part of our admissions process and so we seek your permission to contact your child's current setting via the details you have provided above. *

Yes, I give my permission.

No, I do not give my permission at this time (please let us know if there is a date after which we can contact the school via admissions@ladybarnhouse.org)

Medical or educational circumstances that may require special consideration

Please indicate below if there are any known medical conditions or health problems affecting your child.

Please indicate if your child has any prescribed medication related to the above.

Please indicate below if there are any known allergies affecting your child (including food allergies). Whilst no nuts or products from an environment with nuts are used in the school kitchen, or permitted on site, we cannot guarantee a 100% nut-free environment.

Please indicate if your child has any prescribed medication related to the above.

Please let us know if your child has any visual impairment by providing details. Leave blank if not applicable.

Please let us know if your child has any hearing impairment by providing details. Leave blank if not applicable.

Please let us know if your child has any mobility difficulties by providing details. Leave blank if not applicable.

Consent for administration of paracetamol (Calpol) and antihistamine (Cetirizine) if required.

If administered, the parent will be notified, indicating the name of medication, dosage and time administered.

Calpol consent given.

Cetirizine consent given.

Additional Needs

Please let us know if your child has any behavioural, emotional or social difficulty by providing details. Leave blank if not applicable.

Is there any history of a learning difference on the part of any member of your child's immediate family? *

Please let us know if your child has encountered any difficulties acquiring language skills (speech, understanding, communication) by providing details. Leave blank if not applicable.

What is your child's first language? *

Snacks, Drinks and Outdoor Play

Snacks (e.g. fruit, plain biscuits) are provided by the School for children in Nursery to Prep 4. Please let us know whether your child would like a snack.

Yes
No
Maybe

For children visiting Prep 5 and 6, please provide a small snack for your child. This must be a healthy, nut-free snack (e.g. crackers, fruit).

Would your child like to have milk at break time? *

Yes
No
Maybe

Please provide a filled bottle of water for your child.

A coat should be brought along for outdoor play.

Please ensure that both items are clearly named.

Declaration and Contact Details

Please tick to confirm that you have completed full and complete information on this Disclosures Form and will undertake to update the School on any changes as soon as possible, both before admission and throughout your child's time at the School. *

Please provide the best contact number for the day of your child's visit, in the event that we need to get in touch with you. (Number) *

Signature:

Type your name and sign below

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