Waiting list Posted on July 14, 2014 by administration 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.