Registration Form

Child Details

Sibling Details

Parental Details

Parent/Carer 1

:
:
:
:

Parent/Carer 2

:
:
:
:

Medical Details

Illness and Immunisation Record

Illness
Immunisations
Illness
Immunisations
:
:
:
:
:
:
:
:
:
:
:
:
:
:
:
:
:
:
:
:
:
:
:
:
:
:
:

Doctor's Details

Dietary Requirements and Allergies

Health Visitor

Additional Details

:
:
:
Special Edu. Needs & Disability (SEND):

Booking Pattern

Please select your preferred booking pattern.

Monday:
Tuesday:
Wednesday:
Thursday:
Friday:

Don't worry, this will get re-confirmed for each child when you are offered a childcare place.

Permissions

General Permissions
Outings
Online and Media

Agreement

Information Security

By clicking "Submit Childcare Registration" you agree to us electronically recording and storing this information. All information is secure and will be encrypted using 256-bit encryption technology.

Accurate Information

You confirm that the information you have provided is both complete and accurate and you understand that the giving of false information could invalidate your childcare contract terms and conditions.

Policies and Procedures

I have been taken through the Nursery policy and procedures by the Nursery Manager and fully comprehend the permissions authorised.

Confirmation and Digital Signature

I confirm I have read the terms and conditions of the Nursery and agree to comply with them and any updated regulations and instructions where necessary.

Permissions Authorised:
Information Security
Accurate Information
Policies and Procedures
Confirmation & Signature
Parent Agreement
10/07/2020