Registration Form
If you are interested in placing your child in our care then there are some forms to fill out. Below is a copy
of the registration form.
Use block capitals, complete as much of the form as possible and return it. Please inform the nursery immediately
of any changes to details on the registration form.
Childs full name_______________________________________________
DOB / EDD_________________________________________________
Address________________________________________________________________
____________________________________________Postcode____________________
Telephone_______________________________________________________________
Tick sessions required: See Table
Starting date__________________________
£50 registration fee enclosed?
Mother’s name_______________________________________________
Employer_____________________________________________________________
Address______________________________________________________________
Telephone and mobile_________________________________________
Father’s name________________________________________________
Employer____________________________________________________________
Address_____________________________________________________________
Telephone and mobile__________________________________________
We require a passport photograph of parent/s or guardian/s to enable you to be recognised by staff in all rooms.
Names and signatures of other people that may collect your child
PLEASE ENSURE THEY DO SIGN AS THIS MAY BE USED AS A FORM OF IDENTIFICATION
Name___________________________Signiture_____________________________
Name_____________________________Signiture_____________________________
Friends / Relatives who may be contacted in the event of an emergency:
Name_________________________________________________________________
Address_______________________________________________________________
Relationship_____________________________________________________________
Telephone______________________________________________________________
Name_________________________________________________________________
Address________________________________________________________________
Relationship____________________________________________________________
Telephone_______________________________________________________________
Doctor’s name and surgery______________________________________
Address________________________________________________________________
Telephone_______________________________________________________________
Details of any injections / immunisations your child has received: SEE TABLE
Details of any allergies: __________________________________________________
Please tell us if your child should not be given specific foods on either medical
or religious grounds____________________________________________
Is there any additional information you think we should know about your child? ________________________________________________________
How did you hear about Parklands Day Nursery?___________________________________________________
I wish to apply for admission of my child to Parklands Day Nursery.
I am aware of the regulations of the nursery and agree to comply with them, and understand that the nursery
reserves the right to make amendments to these terms and conditions in the future. This includes permission to take my child
around the grounds although not off the owners premises, permission to arrange to take my child to hospital in an emergency
if necessary and permission to use any photographs of my child for promotions / advertisements unless otherwise indicated.
I have read the information guide and I understand that a full and detailed folder of nursery policies and procedures
is available to view at any time, and that I am required to give 4 weeks notice to cancel this agreement.
Signed: