Child Registration and Permission Application Form

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Registration Details
Please take time to complete this form as accurately as possible and confirm that you have read our Policies Page  
NameYour Child's Full Name
Childs Date of Birth
Home Address
0 /
Parental ResponsibilityWho the child lives with and is responsible for the child
1) Parents / Carers work name and addresses
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1) Parent / Carer Work Contact Number
1) Parent / Carer Home Contact Number
1) Parent / Carer Mobile Number
2) Parents / Carers work name and addressesIf none, input N/A
0 /
2) Parent / Carer Work Contact NumberIf none, input N/A
2) Parent / Carer Home Contact NumberIf none, input N/A
2) Parent / Carer Mobile NumberIf none, input N/A
Legal ResponsibilityHave a court of law deemed anyone to have legal contact with this child?
Emergency Contact 1Full Name
Address
0 /
Phone
Emergency Contact 2Full Name
Address
0 /
Phone
Siblings Names and AgesIf none, input N/A
0 /
Religion
First language
Second Language
Nationality
Other InformationIncluding starting date and days to attend each week, eg Monday/Thursday/Friday
0 /
Previously Attended SettingsHas your child previously attended any other settings, if so please state name, address, phone number and dates attended. If none attended, then input N/A
0 /
PasswordThis is a secure password only known to you and staff to protect the child
Password HintTo help you remember

I will drop off a deposit to secure my childs place (per child) at the respective setting. I understand that this deposit is NON refundable if I do not take up the place. I also understand that this deposit is NON refundable until 4 weeks written notice has been provided, once the place has been taken up. 

Part Time £100.00

Full Time £150 


Please confirm that you have read our Policies Page  before you answer the next question.

Policies ReadYou agree that you have read and understood all our policies listed.
SignedBy inputting your full name, you are signing that all above is true and correct.
Date Signed
Medical Details
Birth Weight or Expected Date of Birth
Infectious illnesses / known medical problemsIf none, input N/A
0 /
Name of Child's GP
Address of GP
0 /
GP Phone
Name of Health Visitor
Address of Health Visitor
0 /
HealthVisitor Phone
Name of Child's Dentist
Address of Dentist
0 /
Dentist Phone
Address and Telephone Number of other AgenciesIf none, input N/A
0 /
AllergiesIf none, input N/A
0 /
Regular Prescribed MedicationIf none, input N/A
0 /
Special Dietary NeedsIf none, input N/A
0 /
Special Physical / Emotional NeedsIf none, input N/A
0 /
Sleep / Rest Routine
0 /
Immunisation Record
Please state clearly each immunisation and date:
8 Weeks - 5 in 1 vaccine, Pneumococcal (PCV) vaccine, Rotavirus vaccine, Men B vaccine
12 Weeks - 5 in 1 vaccine (2nd dose), Rotavirus vaccine (2nd dose)
16 Weeks - 5 in 1 vaccine (3rd dose), Pneumococcal (PCV) vaccine (2nd dose), Men B vaccine (2nd dose)
52 Weeks - HIB (4th dose) MMR, Pneumoccal (PCV) vaccine (3rd dose), Men B vaccine (3rd dose)
2 Years - Children's Flu vaccine
3 Years 4 Months - MMR (2nd dose) & 4 in 1 Pre-School Booster
SignedBy inputting your full name, you are signing that all above is true and correct.
Permission Form
I agree for my child to take part in activities that involve going off site such as visiting parks and short day trips
I consent for staff to seek any emergency medical treatment necessary during the running of the nursery
I agree for my child to occasionally take part in face painting activities
I give permission for my child to be transported via company car etc when considered necessary for trips etc
I consent for my details to be kept on computer in accordance with the Data Protection Act
I consent for my child to have sun cream applied on occasions deemed necessary
I give permission for you to contact my child's previous setting
I agree to my child taking part in the supervised tooth brushing programme and agree that my child can use family fluoride toothpaste.
I agree to my child having photographs and/or video clips taken of them for the following:
Use in local newspapers and advertising campaigns with full name included
Use in displays around the setting and at school information occassions
In your child's individual development file and other children's individual development files and photograph albums. These files are complied over the time that the children are here with us. When the children leave us to go to school, the files are given to our Parents / Carers as a keepsake. The photographs in these files therefore leave the setting with the children and we cannot have responsibility for what happens to them once they leave our setting
For copies of any photographs that are displayed around the setting for Parents / Carers to purchase
For copies of any photographs to be published onto our nursery website, facebook page and any of our nursery social media sites. Once the photographs have been uploaded we cannot be responsible for what happens to them
SignedBy inputting your full name, you are signing that all above is true and correct.
Date Signed
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Password Reset
Please enter your e-mail address. You will receive a new password via e-mail.