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Contact Us/
Student Contact Details Form/

Student Contact Details Form

Student Details

Contact 1 details

Contact 2 details

Contact 3 details

Contact 4 details

Contact 5 details

Student Details

Preferred name Legal name* Date of Birth* Gender Year group* Tutor group* Doctors Surgey Doctors tel no. Medical conditions Dietary needs

How does the student travel to school?BicycleCarTaxiWalksBus

Bus route number if applicable

Do you believe your child may be eligible to qualify as a service child?YesNo

Do you believe your child may be eligible for Free School MealsYesNo

Contact 1 details

Name* Relationship* Home Address*

Does the student reside with you at this address?*YesNo

Home tel. no Mobile tel. no Place of work Work tel. no Email address

If there are no changes to any of the information submitted previously for this student, please tick the box belowText 1

If you ticked the box above then please click next to reach the end of the form to submit.

If you did not tick the box above then please carry on filling out the contact form and submit once you get to the end.

Contact 2 details

Name Relationship

Does this person have legal parental responsibility for the student?YesNo

Does this person live at the same address as the student?YesNo

Home tel. no Mobile tel. no Work tel. no Email address

Contact 3 details

Name Relationship

Does this person have legal parental responsibility for the student?YesNo

Does this person live at the same address as the student?YesNo

Home tel. no Mobile tel. no Work tel. no Email address

Contact 4 details

Name Relationship

Does this person have legal parental responsibility for the student?YesNo

Does this person live at the same address as the student?YesNo

Home tel. no Mobile tel. no Work tel. no Email address

Contact 5 details

Name Relationship

Does this person have legal parental responsibility for the student?YesNo

Does this person live at the same address as the student?YesNo

Home tel. no Mobile tel. no Work tel. no Email address

In this Section:

Contact Us Form
Student Contact Details Form

Luminara Education Trust

Berrywood Road, Duston, Northampton, NN5 6XA

(01604) 460004

office@thedustonschool.org

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