Child / Young Persons Details

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Legal Surname

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Legal Forename

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Chosen Name if Different from Legal Name

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Date of Birth

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Gender as declared on birth certificate

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Male

Female

Prefer Not To Disclose

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Ethnicity

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White British White Irish Traveller of Irish Heritage Any Other White Background Gypsy / Roma White and Black Caribbean Whit and Black Africian White and Asian Any Other Mixed Background Indian Pakistanian Bangladeshi Any Other Asian Background Black Carribbean Black African Any Other Black Background Chinese Any Other Ethnic Group Refused Information Not Yet Obtained

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NCY

Required - Required.

0 / Reception 1 2 3 4 5 6 7 8 9 10 11

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Home Language

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Acholi Adangme Afar-Saho Afrikaans Akan/Twi-Fante Akan (Fante) Akan (Twi/Asante) Albanian/Shqip Alur Amharic Arabic Arabic (any other) Arabic (Algeria) Arabic (Iraq) Arabic (Morocco) Arabic (Sudan) Arabic (Yemen) Armenian Assamese Assyrian/Aramaic Anyi-Baule Aymara Azeri Bamileke (any) Balochi Beja/Bedawi Belarusian Bemba Bhojpuri Bikol Balti Tibetan Burmese/Myanma Bengali Bengali (any other) Bengali (Chittagong/Noakhali) Bengali (Sylheti) British Sign Language Basque/Euskara Bulgarian Cambodian/Khmer Catalan Caribbean Creole English Caribbean Creole French Chaga Chattisgarhi/Khatahi Chechen Chinese Chinese (any other) Chinese (Cantonese) Chinese (Hokkien/Fujianese) Chinese (Hakka) Chinese (Mandarin/Putonghua) Chokwe Cornish Chitrali/Khowar Chichewa/Nyanja Welsh/Cymraeg Czech Danish Dagaare Dagbane Dinka/Jieng Dutch/Flemish Dzongkha/Bhutanese Ebira Edo/Bini Efik-Ibibio Believed to be English* English* Esan/Ishan Estonian Ewe Ewondo Fang Fijian Finnish Fon French Fula/Fulfulde-Pulaar Ga Gaelic/Irish Gaelic (Scotland) Georgian German Gogo/Chigogo Kikuyu/Gikuyu Galician/Galego Greek Greek (any other) Greek (Cyprus) Guarani Gujarati Gurenne/Frafra Gurma Hausa Hindko Hebrew Herero Hungarian Hindi Iban Idoma Igala Igbo Ijo (any) Ilokano Itsekiri Icelandic Italian Javanese Jinghpaw/Kachin Japanese Kikamba Kannada Karen (any) Kashmiri Kanuri Kazakh Katchi Kirghiz/Kyrgyz Khasi Kihaya/Luziba Kinyarwanda Kirundi Kisi (West Africa) Kalenjin Kimbundu Kimeru Konkani Kinyakyusa-Ngonde Kikongo Korean Kpelle Krio Kru (any) Kisii/Ekegusii (Kenya) Kisukuma Kurdish Kurdish (any other) Kurdish (Kurmanji) Kurdish (Sorani) Lao Luba Luba (Chiluba/Tshiluba) Luba (Kiluba) Luganda Lugbara Lugisu/Lumasaba Lingala Lithuanian Lango (Uganda) Lozi/Silozi Lusoga Latvian Luxemburgish Luvale/Luena Lunda Luo (Kenya/Tanzania) Luhya (any) Magahi Maithili Makua Manding/Malinke Manding/Malinke (any other) Bambara Dyula/Jula Maori Marathi Maasai Maldivian/Dhivehi Mende Macedonian Malagasy Malayalam Maltese Malay/Indonesian Malay (any other) Indonesian/Bahasa Indonesia Magindanao-Maranao Mongolian (Khalkha) Manx Gaelic Moore/Mossi Mauritian/Seychelles Creole Munda (any) Maya (any) Nahuatl/Mexicano Nama/Damara Nubian (any) Ndebele Ndebele (South Africa) Ndebele (Zimbabwe) Nepali Norwegian Information not obtained* Nuer/Naadh Nupe Newari Nzema Ambo/Oshiwambo Ambo (Kwanyama) Ambo (Ndonga) Ogoni (any) Oriya Oromo Believed to be other than English* Other than English* Other language Pangasinan Pampangan Pashto/Pakhto Pahari/Himachali (India) Pahari (Pakistan) Panjabi Panjabi (any other) Panjabi (Gurmukhi) Panjabi (Mirpuri) Panjabi (Pothwari) Polish Portuguese Portuguese (any other) Portuguese (Brazil) Persian/Farsi Farsi/Persian (any other) Dari Persian Tajiki Persian Quechua Rajasthani/Marwari Refused* Romany/English Romanes Romani (International) Romanian Romanian (Moldova) Romanian (Romania) Romansch Runyakitara Runyankore-Ruchiga Runyoro-Rutooro Russian Samoan Serbian/Croatian/Bosnian Bosnian Croatian Serbian Scots Shilluk/Cholo Shona Sidamo Sign language (other) Slovak Slovenian Sindhi Sango Sinhala Somali Spanish Sardinian Siraiki Sotho/Sesotho Sotho/Sesotho (Southern) Sotho/Sesotho (Northern) Swazi/Siswati Tswana/Setswana Sundanese Swahili/Kiswahili Swahili (any other) Comorian Swahili Swahili (Kingwana) Swahili (Brava/Mwiini) Swahili (Bajuni/Tikuu) Swedish Tamil Telugu Temne Teso/Ateso Tigre Tagalog/Filipino Filipino Tagalog Tigrinya Thai Tibetan Tiv Berber/Tamazight Berber/Tamazight (any other) Berber/Tamazight (Kabyle) Berber (Tamashek) Tonga/Chitonga (Zambia) Tongan (Oceania) Tok Pisin Traveller Irish/Shelta Tsonga Turkmen Tulu Tumbuka Turkish Ukrainian Umbundu Urdu Urhobo-Isoko Uyghur Uzbek Venda Vietnamese Visayan/Bisaya Visayan/Bisaya (any other) Hiligaynon Cebuano/Sugbuanon Waray/Binisaya Wa-Paraok (South-East Asia) West-African Creole Portuguese Wolof West-African Pidgin English Xhosa Yao/Chiyao (East Africa) Yiddish Yoruba Zande Zulu

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Religion

Required - Required.

No religion Christian (including Church of England, Catholic, Protestant and all other Christian denominations) Buddhist Hindu Jewish Muslim Sikh Other

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Admission Date

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Leaving Date

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Social Care Status

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Not Known / Not Applicable

CIN

CP

LAC

Allocated

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SEN Status

Required - Required.

K - SEN Support

E- EHCP

N - No SEN Identified