Waiting list of Les Petites Etoiles West Hampstead

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 days4 days5 days

special request (optional)

__________________________________________________________________________

I understand that:
I am choosing the bilingual programme (this is the incorrect form for the English-only option). See parent policy booklet for full-details.
During the school year - September to August - Les Petites Etoiles West Hampstead welcomes children who are at least 6 month-old in September.

__________________________________________________________________________

PARENT / CARER 1

First name

Family name

Parental responsibility yesno

Telephone (mobile)

Telephone (home)

Telephone (work)

Email

Address

Does the child live at this address? yesno

__________________________________________________________________________

PARENT / CARER 2

First name

Family name

Parental responsibility yesno

Telephone (mobile)

Telephone (home)

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 or 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).

__________________________________________________________________________

PRIVACY POLICY

I have read and agree to the terms of the Privacy Policy

__________________________________________________________________________

REGISTRATION FEE

Δ