Author: Ms A Darlison (Staff)

ATTEND Form for Parents/Carers
For the assessment of factors contributing to school non-attendance

Name of Child: Year/Form/Class:
Completed by (name and relations to student):
Date:

My child’s strengths
What are they good at? What do they enjoy?
When have they had good attendance at school?
What helps?
Who are their friends?
If you could name one adult they trust , who would it be?

What is stopping my child from going to school? Circle or highlight.

Worry
My child is worried about:
open spaces being bullied getting sick/germs/viruses
feeling trapped having a panic attack doing badly in lessons
crowds public transport socialising with other people
the school bus getting into trouble something else______________
My child is so afraid of school that they:
sweat breath too fast cry have a racing heart
panic run away get angry find it hard to sleep
Health and wellbeing
My child has:
migraine headaches IBS dyspraxia severe period pains
an eating disorder ADHD dyslexia hearing problems
sight problems (including CVI) OCD depression anxiety/panic attacks
speech and language difficulties autism seizures physical disability
Another condition not listed here_____________________________________________________
My child feels like they are in the wrong gender body
Sensory overload
My child finds it hard to put up with:
the fabric of school uniform smells moving between lessons
being too close to others noise bright lighting
something else in the school environment_______________________________________________
Fitting in
My child is being bullied My child has a bad reputation at school
My child recently lost a good friend My child feels lonely and doesn't have friends
My child has recently fallen out with someone
My child is having problems involving social media or cyberbullying
My child feels they don’t fit in with others / they struggle at lunch and break times
My child feels they don’t fit in with others because they are a different religion or race
My child feel they don’t fit in with others because they are gay/lesbian or have a different gender identity
School work and teachers
My child finds find work too hard / easy My child doesn't trust the teachers
My child is having trouble with a certain teacher My child finds school rules too strict
My child worries teachers will get angry with them My child is worried about exams
My child is worried about doing PE or getting changed for PE

Changes
My child recently moved (circle or highlight):
schools from primary to secondary year group house
to the UK
English is not my child’s first language and they are still learning it
Things at home
I, or another parent or carer, has physical or mental health problems
I worry a lot about the physical and mental health of my child
It is not always safe at home because of fighting and arguments, drinking or drugs
We have had a death in our family
We have had stressful things to cope with at home (e.g. house fire, burglary, redundancy)
We have had a big change in our family (e.g. new baby, new parent/carer, new step-siblings, divorce or separation)
My child sometimes has to look after me, another parent/carer or brothers and sisters due to physical or mental health difficulties
We worry a lot about having enough money
There are lots of problems with where we live (e.g. damp, too crowded, we keep having to move, disagreements with neighbours or landlord)
I find it hard to get my child to school in the mornings for practical reason (e.g. other children with additional needs, transport issues, health problems)
My child feels really worried about being away from me or another parent/carer—they find it distressing when we separate
We don’t feel school is that important in our family—we think there are other ways of learning things
Other things that stop my child getting back to school
My child has access to comforts (e.g. computer, phone, play station or X-box, internet, TV, food, staying in bed or on the sofa, cigarettes, drugs)
My child has a girlfriend/boyfriend off school
My child is influenced by friends who are also off school
Other people in our family are at home during the day
My child works and earns money while they are out of school
My child gets extra attention from, and time with, me or another parent/carer
My child can completely control their environment at home (e.g. what they wear, who they see, when they go to bed or get up, what they eat, routines)
I am worried my child might be:
involved in gang activities
Influenced by a radical religious or nationalist group
At risk of being sexually exploited by someone older than them
My child does a lot of online gaming and has friends though it
My child feels they are learning what they need to online or through friends or family
My child feels that school is pointless and does not want to be a part of ‘the system’

Things that make it harder for my child to go back to school
My child doesn't know how to explain why they have been away to friends
My child worries about facing teachers
My child worries that if they get into school, they won’t be allowed to leave if they need to
My child feels safe at home
My child doesn't think they can catch up with school work that they missed
No--one is really helping my child
My child goes to bed too late or sleeps badly and has trouble waking up early. My child feels tired and sometimes catches up with sleep during the day
People disagree about how to help my child
My relationship with my child’s school is strained/has broken down

Is there anything else that stops your child going to school ?
Of all the reasons circled or highlighted on this form, which are the most important?
What is your biggest concern?
What actions and interventions would you hope to secure for your child?