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School Nursing (St Helens)
-
Reception school entry questionnaire
Reception school entry questionnaire
Step
1
of
3
33%
Registered School in St Helens from September 2023
*
Please select
Allanson Street Primary School, Parr
Ashurst Primary School, Blackbrook
Bleak Hill Primary School, Windle
Broad Oak Community Primary School, Broad Oak
Carr Mill Primary School, Moss Bank
Chapel End Primary School, Billinge
Corpus Christi RC Primary School, Rainford
The District CE Primary School, Newton-le-Willows
Eaves Primary School, Sutton
Eccleston Lane Ends Primary School, Eccleston
Eccleston Mere Primary School, Eccleston
Garswood Primary and Nursery School, Garswood
Grange Valley Primary School, Haydock
Haydock English Martyrs' RC Primary School, Haydock
Holy Cross RC Primary School, St Helens
Holy Spirit RC Primary School, Parr
Legh Vale Primary School, Haydock
Longton Lane Community Primary School, Rainhill
Lyme Community Primary School, Newton-le-Willows
Merton Bank Primary School, Merton Bank
Newton-le-Willows Primary School, Newton-le-Willows
Nutgrove Methodist Primary School, Nutgrove
Oakdene Primary School, Rainhill
Parish CE Primary School, St Helens
Queen's Park CE/URC Primary School, Dentons Green
Rainford Brook Lodge Community Primary School, Rainford
Rainford CE Primary School, Rainford
Rectory CE Primary School, North Ashton
Rivington Primary School, Dentons Green
Robins Lane Community Primary School, Sutton
St Aidan's CE Primary School, Billinge
St Anne's RC Primary School, Sutton
St Ann's CE Primary School, Rainhill
St Austin's RC Primary School, Nutgrove
St Bartholomew's RC Primary School, Rainhill
St James's CE Primary School, Haydock
St John Vianney RC Primary School, Thatto Heath
St Julie's RC Primary School, Eccleston
St Mary & St Thomas' CE Primary School, St Helens
St Mary's RC Infant School, Newton-le-Willows
St Mary's RC Junior School, Newton-le-Willows
St Mary's RC Primary School, Billinge
St Mary's RC Primary School, Blackbrook
St Peter and St Paul RC Primary School, Haresfinch
St Peter's CE Primary School, Newton-le-Willows
St Teresa's RC Primary School, Dentons Green
St Theresa's RC Primary School, Sutton
St Thomas of Canterbury RC Primary School, Windle
Sherdley Primary School, Sutton
Sutton Manor Community Primary School, Sutton
Sutton Oak CE Primary School, Sutton
Thatto Heath Community Primary School, Thatto Heath
Wargrave CE Primary School, Newton-le-Willows
Willow Tree Primary School, Sutton
Other
Please comment
About Parent/Carer
Your Name
*
Are you a member of the armed forces?
Please Select
Yes
No
Relationship to child
*
Please Select
Parent
Relative
Guardian
Carer
Foster Carer
Person with parental responsibility
Child's full name
*
Ethnicity
*
Please Select
Asian / Asian British – Indian
Asian / Asian British – Pakistani
Asian / Asian British – Bangladeshi
Asian / Asian British – Chinese
Any other Asian background
Black / Black British / Caribbean / African – Caribbean
Black / Black British / Caribbean / African – African
Any other Black, Black British, or Caribbean background
Mixed or multiple ethnic groups – White and Black Caribbean
Mixed or multiple ethnic groups – White and Black African
Mixed or multiple ethnic groups – White and Asian
Any other Mixed or multiple ethnic background
White – English, Welsh, Scottish, Northern Irish or British
White – Irish
White – Gypsy or Irish Traveller
White – Roma
Any other White background
Other ethnic group
Child's Date of Birth
*
Day
Month
Year
Address Line 1
*
Address Line 2
*
Town or City
*
Post Code
*
Telephone Number
*
Email address
*
Other members of the household
Household member 1
Member 1 Name
Member 1 Date of Birth
Day
Month
Year
Member 1 Relationship to child
Please Select
Parent
Relative
Guardian
Person with parental responsibility
Other
Household member 2
Member 2 Name
Member 2 Date of Birth
Day
Month
Year
Member 2 Relationship to child
Please Select
Parent
Relative
Guardian
Person with parental responsibility
Other
Household member 3
Member 3 Name
Member 3 Date of Birth
Day
Month
Year
Member 3 Relationship to child
Please Select
Parent
Relative
Guardian
Person with parental responsibility
Other
Add Household Member 4
Add
Household member 4
Member 4 Name
Member 4 Date of Birth
Day
Month
Year
Member 4 Relationship to child
Please Select
Parent
Relative
Guardian
Person with parental responsibility
Other
Add Household Member 5
Add
Household member 5
Member 5 Name
Member 5 Date of Birth
Day
Month
Year
Member 5 Relationship to child
Please Select
Parent
Relative
Guardian
Person with parental responsibility
Other
Add Household Member 6
Add
Household member 6
Member 6 Name
Member 6 Date of Birth
Day
Month
Year
Member 6 Relationship to child
Please Select
Parent
Relative
Guardian
Person with parental responsibility
Other
About your child
Is your child under the care of any services? (NHS services / social care)
Please Select
Yes
No
If yes, please indicate which services from the list below.
Paediatrician
Speech & Language Therapy
Physiotherapy
Occupational Therapy
Orthoptist / Eye Clinic
Audiology / Ear, Nose and Throat (ENT) Clinic
Child and Adolescent Mental Health Services (CAMHS)
Continence (bladder and bowel problems)
Social care
Other
If your child is attending another clinic, please specify
Are your child's immunisations up to date (including pre-school booster)?
*
Yes
No
Unsure
Please contact your GP to ask about the immunisations your child needs.
Is your child registered with a dentist?
*
If your child is not registered with a dentist please visit
www.nhs.uk/service-search
to find your local practice
Yes
No
Does your child have a long-term health condition?
*
Yes
No
If your child has a long-term health condition, please specify
*
Does your child suffer from any severe allergies?
*
Yes
No
If your child suffers from any severe allergies, please specify
*
Do you have any concerns about your child with any of the following
We may be able to provide some resources
Eating habits
Sleeping
Behaviour
Speech & Language
Excessive clumsiness
Does your child have any toileting or bedwetting problems?
*
Yes
No
Do you have any concerns regarding your child being under or overweight?
*
Yes
No
All children in reception can take part in the
national child measurement programme.
With consent from a parent/carer, children are weighed and measured at school by the school nursing team. The Henry programme is also available in St Helens. The free 8 week course covers: emotional wellbeing, healthy weight, parenting skills, oral health, nurturing relationships, physical activity, sleep, activity ideas.
Find out more.
Is your child on any medication?
*
Yes
No
If your child is on medication, please give details
*
Does your child have any vision problems?
*
Your child will have a vision check in reception. If you have any concerns about your child’s vision now or in the future, please contact any local opticians for a free eye test.
Yes
No
Does your child have any hearing problems?
*
Your child will be offered a hearing test whilst they are in reception.
Yes
No
Would you like the school nursing team to contact you regarding any concerns you have highlighted within questionnaires?
Please Select
Yes
No
If yes, how would you like to be contacted?
Please Select
Telephone
Email
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