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

Your Email

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 days
MondayTuesdayWednesdayThursdayFriday
I am flexible on which days my child attends

__________________________________________________________________________

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

Languages spoken at home to your child:

Languages spoken at home in front of your child:

__________________________________________________________________________

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

__________________________________________________________________________

EMERGENCY CONTACTS (authorised to collect your child)

Name of emergency contact

Relationship to child

Telephone

Address

__________________________________________________________________________

How did you hear about us?

Did you visit any other nurseries?

Why did you choose us?

__________________________________________________________________________

MEDICAL INFORMATION

Is attendance at hospital or clinic still necessary? Please give details.

Does your child have any special health or educational needs, e.g. speech therapy?

__________________________________________________________________________

EMERGENCY TREATMENT CONSENT

In events of a medical emergency we will endeavour to contact you using the information you have supplied within this form 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. Please complete this with your application:

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).

__________________________________________________________________________

HOME VISITS

I understand that I can request a home visit from my child’s key worker and Manager before my child begins attending nursery. I further understand that this is not something I must do, but something I can request if I feel it would benefit my child.

I would like a home visitI would not like a home visit.

IIf you would like a home visit, please telephone the school 2 weeks before your preferred
start date to make an appropriate appointment.

__________________________________________________________________________

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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