Personal Information for Students

Please complete ALL sections in BLOCK CAPITALS

Student’s details:-
Legal Forename ABDEEN

Legal Middle Name MUTAZ

Legal Surname ADAM

Preferred Surname ADAM

Preferred Forename ABDEEN Male Female

Date of birth 07/03/2008

Home address
No. and street name 343 LONDON ROAD

Town BEDFORD

Postcode MK42 0PX

Name of any related pupil

Full name Relationship to above Schools attending
student

Emergency contact information

Please enter contact details in the order in which you wish them to be contacted in the event of an emergency

1st Contact
Title Mr Mrs Ms Miss Other (Please specify)
Full Name MUTAZ OBAID ADAM

Address if different
to student address
Contact 1 telephone numbers Tick priority contact number
Home

Mobile 07825279364

Work

Email address mutazadam@hotmail.com

Relationship to child: FATHER Parental responsibility: YES NO

Is correspondence to be sent to the above named contact YES No
Are text messages to be sent to the above named contact Yes No
Are school reports to be sent to the above named contact Yes No
Personal Information form – Update March 2020
2nd Contact
Title Mr Mrs Ms Miss Other (Please specify)
Full Name HIBA ABDIN ALI AHMED

Address if different
to student address
Contact 2 telephone numbers Tick priority contact number
Home

Mobile 07825279364

Work

Email address hiba.abdin@hotmail.com

Relationship to child: MOTHER Parental responsibility: YES NO

Is correspondence to be sent to the above named contact YES No
Are text messages to be sent to the above named contact Yes No
Are school reports to be sent to the above named contact Yes No

3rd Contact
Title Mr Mrs Ms Miss Other (Please specify)
Full Name MOHAMED OBAID ADAM

Address if different 9 COSTIN STREET, BEDFORD, MK40 1RD

to student address
Contact 3 telephone numbers Tick priority contact number
Home

Mobile 07897446999

Work

Email address adammsc@hotmail.com

Relationship to child: UNCLE Parental responsibility: YES NO

Is correspondence to be sent to the above named contact YES No
Are text messages to be sent to the above named contact Yes No
Are school reports to be sent to the above named contact Yes No

Name of PREVIOUS SCHOOL attended

Previous school name KIBEIDA INTERNATIONAL SCHOOLS
Previous school address and GHW5+CWM, KKARTOUM, SUDAN
telephone number +249183520873

Dinner arrangements (please indicate)

Free school meal Paid school meal Packed lunch

Medical Information
Doctor’s Name TARIQ KHOKHAR
Practice Name QUEENS PARK SURGERY
Practice Address 23C CARLISLE ROAD, QUEENS PARK, BEDFORD, MK40 Practice telephone number
4HR 01234351661

Personal Information form – Update March 2020

 Please give details of
any health problems

Do you give school permission to administer Yes No

paracetamol if necessary? (please indicate)

The Department for Education requires that all schools record the nationality, ethnic background, first language
and country of birth for all students.
Please complete the details below:

Nationality: (as on passport/EEA Identity Card/official document) BRITISH

Multiple Nationality (Dual Nationality if applicable)
Country of birth: (eg. Scotland, France, Pakistan) ENGLAND

Child’s first language: First language is the language your ARABIC

child heard first as a baby. It will be a language they still have contact
with at home or in the community, even if they usually speak English
now.

Child’s ethnic group: Please tick one box from the grid below:

Afghan Croatian Malaysian Chinese Taiwanese

African Asian Egyptian Mirpuri Pakistani Thai
Albanian Filipino Moroccan Traveller of Irish
heritage
Arab Greek Nepali Turkish
Asian and any other ethnic Greek Cypriot Other Asian Turkish Cypriot
group
Asian and Black Gypsy Other Black Vietnamese
Asian and Chinese Gypsy/Roma Other Black African White - Cornish
Bangladeshi Hong Kong Chinese Other Chinese White - English
Black – Angolan Indian Other ethnic group White - Irish
Black – Congolese Iranian Other Gypsy/Roma White - Scottish
Black – Ghanaian Iraqi Other mixed background White – Welsh
Black – Nigerian Italian Other Pakistani White and Black African
Black - Sierra Leonian Japanese Other White British White and Black
Caribbean
Black – Somali Kashmiri other Polynesian White and Chinese
Black – Sudanese Kashmiri Pakistani Portuguese White and Indian
Black and any other ethnic Korean Refused White and Pakistani
group
Black Caribbean Kosovan Roma White Eastern European
Black European Kurdish Serbian White European
Black North American Latin/South American Singaporean Chinese White Other
Bosnian-Herzegovinian Lebanese Sri Lankan Sinhalese White Western European
Chinese Libyan Sri Lankan Tamil Yemeni
Chinese + any other ethnic Malay
group

Travel arrangements (Please indicate)

Walk Bus Cycle Train Car Other

From 2014 the Government have introduced an additional category to the pupil premium funding,
called;
Pupil Premium Plus
In order for the school to access the funding we need parents/guardians to inform the school of
these circumstances. However this is not obligatory and it is completely at parent’s discretion. If you
choose to inform the school and the situation applies, please select one of the following:-
Has been looked after for one day or more
Ceased to be looked after through adoption

Personal Information form – Update March 2020

 Ceased to be looked after through a special guardianship order or residence order

Does your child have any special educational needs? (Please indicate) . If Yes please bring
details of diagnosis to meeting

No Yes EHCP Yes/No

Please give details:

Does your child have any disabilities?

Yes No
Please give details:

Other information

Is your child currently supervised under either a Child Protection Plan or Child In Yes No
Need Plan (Please indicate)
Are any court orders applicable to your child? (Please indicate) Yes No

Please give details if you have answered yes to either of the above…

Are any other professionals working with the family i.e. Education Welfare, Early Yes No
Help Team
Please give details if you have answered yes to either of the above…

General Data Protection Regulation

Bedford Free School holds a lot of personal information – about pupils, parents, teachers etc. and the
new General Data Protection Regulation is the law that says how we can hold, use and store it.
We have a Trust wide privacy notices for students and parents / carers which tell you what personal
information we collect and hold, what we do with it, who we share it with and how long we keep it for as
well as other important information.
The new law gives people more rights about how their personal information is handled. You can find out
more about this on the Information Commissioner’s Office (ICO) website. If you want to use one of your
new rights please contact the school office on 01234 332299 and one of our team will be in touch with
you.
Please rest assured that our school knows how important your and your child’s information is, and takes
all appropriate measures to make sure it is kept safe and secure, processed lawfully and fairly and only
shared with people that the law allows us to.

I agree that the information given in this form is accurate and will contact the school of any
changes to the details given at the earliest opportunity.

Signature of Parent/ Guardian: …………………………………………………………………………………………………………..

Print name: ……………………………………………………………………...Date:……12/06/2023…………………….……..

Personal Information form – Update March 2020

 Permissions Forms

Child’s name: _____ABDEEN ADAM___________________________________________

Image consent form

 I consent to my child’s image appearing in marketing or promotional material used by

Bedford Free School including the Internet. I understand that the School may retain and
use the image for the purposes outlined.

 I do not wish for my child’s image to appear on any material relating to Bedford Free
School.

I understand that I can withdraw this consent at any time by writing to the School.
_________________________________________________________

Data exchange:

 I consent to Bedford Free School contacting my child’s current school

Name of school: __________________________________________________

Youth support services agreement:

I consent to Bedford Free School passing my child’s details onto the above
for careers advice.

CONSENT FORM FOR THE USE OF BIOMETRIC INFORMATION AT BEDFORD FREE SCHOOL

Having read the guidance provided to me by Bedford Free School. I give consent to information from the
fingerprint of my child being taken and used by the school for use as part of an automated biometric
recognition system for the purpose of the cashless system.

I understand that I can withdraw this consent at any time by writing to the school.

Name of Parent: ____MUTAZ ADAM______________________________________

Signature: _________________________________________Date: ___12/06/2023_____

Personal Information form – Update March 2020

 CONSENT FOR SCHOOL TRIPS, ELECTIVES &

OTHER OFF-SITE ACTIVITIES

Please sign and date the form below if you are happy for your child:

a) To take part in school trips and other activities that take place off school premises; and
b) To be given first aid or urgent medical treatment during any school trip or activity.
Please note the following important information before signing this form:

 The trips and activities covered by this consent include;

o all visits (including residential trips) which take place during the holidays or a
weekend
o adventure activities at any time including Electives
o off-site sporting fixtures outside the school day,

 The school will send you information about each trip or activity before it takes place.

Written parental consent will not be requested from you for the majority of off-site activities
offered by the school – for example, year-group visits to local amenities – as such activities
are part of the school’s curriculum and usually take place during the normal school day.

Please complete the medical information section below (if applicable) and sign and date this
form if you agree to the above.

MEDICAL INFORMATION

Details of any medical condition that my child suffers from and any medication
my child should take during off-site visits:

Child’s name: ___________________________________________________

Signed: ________________________________________Date:____________

Personal Information form – Update March 2020

NAME OF STUDENT: …………………………………… DOB: ……………

Please complete and return this form to the school. If a reply is not received the school will
presume you grant permission.

PARENT/CARER

As the parent or carer of the student below:

I have read the school’s ICT Acceptable Usage Policy and I do / do not (delete as appropriate)
grant permission for my son or daughter to use the school’s ICT systems, electronic mail and the
internet.

I understand that students will be held accountable for their own actions when using the school’s
internet, network and ICT systems.

I also understand that some materials on the internet may be objectionable and I accept
responsibility for setting standards for my daughter or son to follow when selecting, sharing and
exploring information and media.

I accept the school’s mobile phone policy.

Signed: ……………………………………………. Date: ………………………………..

Parent/Carer

Please print: ……………………………………………………………………

Parent/Carer’s name

Home telephone: ……………………………………………….

If permission has been granted by the parent/carer, then the student must sign below.

STUDENT

As a school user of the internet, network and ICT systems, I agree to comply with the school rules
on its use. I will use the internet, network and ICT systems in a responsible way and will observe
all the restrictions made by the school.

I accept the school’s mobile phone policy.

Signed: ……………………………………………. Date: ………………………………..

Student Name:-

Personal Information form – Update March 2020

Personal Information form – Update March 2020