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.
Complete as much of the form as possible and return it with the registration fee. Please inform the nursery immediately
of any changes to the details on this registration form.
Child's Full Name____________________________________________________
DOB / EDD_________________________________________________________
Address____________________________________________________________
____________________________________________Postcode_______________
Telephone__________________________________Email
___________________
Tick sessions required: See Table
Starting
date__________________________
£50 registration fee enclosed?
Mother’s / Guardian's name____________________________________________
Employer
and Employer's address_______________________________________
__________________________________________________________________
Work Telephone __________________________Mobile_____________________
Signature
of mother/guardian _________________________Date ____________
Father’s
/ Guardian's name_____________________________________________
Employer and Employer's
address_______________________________________
___________________________________________________________________
Work Telephone ______________________________Mobile_________________
Signature of
Father/ Guardian______________________Date _______________
We require a passport photograph
of parents/guardians and anyone else who may collect.
Names and signatures of other people
that may collect your child.
Name___________________________Signature___________________________
Name_____________________________Signature_________________________
Friends / Relatives who may be contacted in the event of an emergency:
Name_____________________________________________________________
Address___________________________________________________________
Relationship________________________________________________________
Telephone______________________________Mobile______________________
Name______________________________________________________________
Address____________________________________________________________
Relationship_________________________________________________________
Telephone___________________________________Mobile__________________
Doctor’s
name and surgery_____________________________________________
Address____________________________________________________________
Telephone__________________________________________________________
Details of
any injections / immunisations your child has received: SEE TABLE
Additional information.
Who has parental responsibility?
Any health requirements?
Any dietary requirements?
Language
spoken at home:
Religion:
Your child's ethnicity:
Is there any
additional information you think we should know about your child? ________________________________________________________
How did you hear about Parklands Day Nursery?___________________________________________________
I give permission for my child's name and photograph to be used in the local paper:
Y / N
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:
