Registration Note: Only United Kingdom residents are eligible Child's DetailsChild's First name *Child's Surname *Gender *MaleFemaleDate of Birth *Ethnic Origin *Languages Spoken *Religion *Which of the parents/carers below does the child normally live with? *Parent or Carer's DetailsParent or Carer 1First Name *Surname *Date of Birth *Relationship to Child *Occupation *Home Address *City *ZIP / Postal code *Home Phone *Mobile Phone *Email Address *Work Address *City *ZIP / Postal code *Office Phone *Email Address *Does the person have legal “parental responsibility” for the child? *YesNoParent or Carer 2First Name *Surname *Date of Birth *Relationship to Child *Occupation *Home Address *City *ZIP / Postal code *Home Phone *Mobile Phone *Email Address *Work Address *City *Office Phone *Email Address *Does the person have legal “parental responsibility” for the child? *YesNoAlternative Emergency ContactEmergency Contact 1First Name *Surname *Relationship to Child *Mobile No. *Collection password (if child is to be collected by someone not known to the nurseryEmergency Contact 2First Name *Surname *Relationship to Child *Mobile No. *Collection password (if child is to be collected by someone not known to the nursery)Health InformationChild's DoctorFull Name *Street Address *City *ZIP / Postal code *Phone *Child's Health VisitorFull Name *Street Address *City *ZIP / Postal code *Phone *Allergies and dietary requirementsDoes your child have any allergies? *YesNoIf so, please give full details below *Does your child have any dietary requirements that are not due to allergies? *YesNoIf so, please give full details below *If you answered YES to either of the above questions, is the exposure to the allergen or failure to comply with the dietary requirement likely to result in serious harm to your child’s health as far as you are aware?YesNoNoteIf this information changes in the future, please notify the nursery immediately on a “Change to Allergy or Dietary Requirements” form. Please give us as much detail as possible, including specific ingredients.Medication requirementsDoes your child have any regular medication? *YesNoIf so, please give full details below *Other informationDoes your child have siblings? *YesNoIf so, please give full details below *Does your child known to the Social Services? *YesNoIf so, please give full details below *Does your child have any special educational needs or disabilities? *YesNoIf so, please give full details below *Has your child been referred to a specialist for support or disabilities? *YesNoIf so, please give full details below *AuthorisationsEmergency Medical TreatmentIn the event of an emergency, the nursery staff will take your child to a doctor or to the hospital treatment or call an ambulance. If you do not consent to this, please speak to the Nursery Manager before completing this form so that alternative arrangements can be explored.Do you give permission for the nursery staff to seek emergency medical advice and/or treatment for your child? *YesNoNappy CreamWe supply Sudocrem ™ and staff members will apply this if and when they feel that it is needed.If you would prefer that we do not apply nappy cream to your child, please tick the "NO" box.Do you give permission for the nursery staff to apply nappy cream to your child if needed? *YesNoSun CreamIwe require your authorisation in order to be able to apply sun cream to your child.We supply sun cream and staff members will apply this if and when they feel that it is needed. If you do not consent to this, please speak to the Nursery Manager so that alternative arrangements can be made.Do you give permission for the nursery staff to apply sun cream to your child if needed? *YesNoOutings that do not require Motorised TransportFrom time to time, the nursery will take the children out on walks to visit shops, the library, the park and other local attractions. Appropriate staff ratios will be maintained at all times and procedures are in place to manage and reduce risks.Do you give permission for your child to be taken on outings that do not involve the use of motorised transport? *YesNoPhotographs (Internal Use)We take photographs and short videos of children participating in learning activities to be used in displays around the nursery and in the children's development records.Do you give permission for photographs and videos to be taken of your child and used for the purposes described? *YesNoPhotographs (External Use)Iwe take photographs and short videos of children participating in learning activities and share these with current and potential new parents on the nursery's described? Facebook page, website, newsletter etc. Photographs may also appear in other printed electronic media accessible to the public (e.g. local newspapers) in connection with the nursery's marketing efforts.Do you give permission for photographs and videos to be taken of your child and used for the purposes described? *YesNoBooking RequestPreferred start date *Please detail the session that you would like to book *Choose SessionMondayTuesdayWednesdayThursdayFridayImportant Notice*Please bring your child’s red book, birth certificate and proof of address at the time of registrationConsent *Yes, I agree with the terms and conditions and that: 1. This application form has been correctly completed to the best of your knowledge.2. You have read and thereby agree to abide by the terms and conditions detailed above.3. You agree that you are jointly and severally liable to pay the nursery's fees in accordance with the payment terms above.Submit
