Concern Box — Highams Park School

Student reporting (you do not have to complete this) :

Student Name you have concern for: *

Year Group:

What concern do you have for them? (please give more details below) *

Bullying

Home Life

Well-being

Other

If other, please state:

If bullying, what type of bullying

Physical

Emotional

Gender-related

Verbal

Homophobic

Racist

Date/Time of incident(s)

Details of incident(s) *