Liste d’attente

This form must be completed by a person with parental responsibility. Parents are responsible for ensuring that all information on the form is correct.

Your Name

I have parental responsibility for the child named bellow, and I will be responsible for paying the fees.
__________________________________________________________________________

YOUR CHILD

First name of child

Family name of child

BoyGirl

Date of birth

Requested admission date

Requested number of days per week
2 days3 days5 days

special request (optional)

__________________________________________________________________________

PARENT / CARER 1

First name

Family name

Parental responsibility yesno

Telephone (home)

Telephone (mobile)

Telephone (work)

Email

Address

Does the child live at this address? yesno

__________________________________________________________________________

PARENT / CARER 2

First name

Family name

Parental responsibility yesno

Telephone (home)

Telephone (mobile)

Telephone (work)

Email

Address (if different than Parent / carer 1 's address)

Does the child live at this address? yesno

__________________________________________________________________________

Languages spoken at home to your child:

Languages spoken at home in front of your child:

__________________________________________________________________________

EMPLOYER / COLLEGE DETAILS

Parent 1 - occupation

Parent 1 - Name and address of Employer / College

Parent 2 - occupation

Parent 2 - Name and address of Employer / College

__________________________________________________________________________

How did you hear about us?

Did you visit any other nurseries?

Why did you choose us?

__________________________________________________________________________

EMERGENCY TREATMENT CONSENT

In events of a medical emergency we will endeavour to contact you as parents/carer/guardian and named emergency contacts. If this proves not possible and your child needs emergency medical treatment a member of staff will accompany your child to hospital if necessary. We must therefore have your permission in this respect.

I hereby give consent for my/our child to receive emergency medical treatment as appropriate in the event of a medical emergency.

Please state below any medical procedures you would not wish your child to have (e.g.
blood transfusion).

__________________________________________________________________________

REGISTRATION FEE

Please pay £75 to register your child on the waiting list. This is non-refundable and does not guarantee a place.

 

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