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:

    __________________________________________________________________________

    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