Summer HAF Referrals
Activity Selection
Please select the scheme you are applying for:
Please choose a value
Brettenham (9-11 Year Olds)
Churchfield - (5-11 Year Olds)
Eldon - (9-11 Year Olds)
Fleecefield - (9-11 Year Olds)
Galliard - (5-11 Year Olds)
Houndsfield - (9-11 Year Olds)
Millfield House - (11-13 Year Olds)
St John & St James - (9-11 Year Olds)
Identity
Forename
Surname
DateOfBirth
School
Please choose a value
Brettenham Primary
Churchfield Primary
Cuckoo Hall Primary
Edmonton County Primary
Edmonton County Secondary
Eldon Primary
Fleecefield Primary
Galliard Primary
Houndsfield Primary
Latymer All Saints Primary
Meridian Angel Primary
N/A (Not In Partnership)
Oakthorpe Primary
Raynham Primary
St Edmunds Primary
St John & St James Primary
Starks Field Primary
West Lea
Wilbury Primary
Woodpecker Hall Primary
Other
SEN (Please provide details if Yes)
Please choose a value
Yes
No
Other
Further Details
Demographic
Gender
Please choose a value
F
M
Ethnicity
Please choose a value
White or White British
Preferred Not to Say
Asian or Asian British
Black or Black British
Any Other White Background
Any Other Black Background
Black British Caribbean
Black British African
Mixed White & Black Carribean
Mixed White & Black African
Kurdish
Other
Mixed White & Asian
Any Other Mixed Background
Any Other Asian Background
Turkish Cypriot
Turkish
Greek
Medical/Dietary Requirements:
Does the student named on this form currently receive Free School Meals, or qualify for Pupil Premium Funding?*
Free School Meals
Pupil Premium Funding
No
Emergency Contact Details
Name
Relationship to Child
Email
Telephone
Mobile Number
Additional Number (State Name & Relationship)
Photographic/Video Consent
Edmonton Community Partnership often uses photographic material and video footage for our promotional materials. Please confirm whether the student named on this form has consent for use on our flyers/social media/website.
Please choose a value
Yes, ECP has consent to use photos/footage of the student named on this form for use on the company's website/promotional material.
No, ECP does not have consent to use photos/footage of the child named on this form for use on the company's website/promotional material.
Submit