NURSERY REGISTRATION FORM

CHILD'S MEDICAL HISTORY
DOES YOUR CHILD TAKE ANY REGULAR MEDICATION?*

YESNO
DOES YOUR CHILD SUFFER FROM A MEDICAL CONDITION? (E.G. EPILEPSY, ASTHMA, DIABETES ETC.)*

YESNO
IF YES, PLEASE STATE THE CONDITION:*
DOES YOUR CHILD HAVE ANY SPECIAL EDUCATIONAL NEEDS OR DISABILITIES?*

YESNO
IF YES, PLEASE GIVE DETAILS:*
DOES YOUR CHILD HAVE ANY ALLERGIES?*

YESNO
IF YES, PLEASE GIVE DETAILS:*

WHO WOULD YOU LIKE TO RECEIVE COMMUNICATION FROM THE SCHOOL - PLEASE TICK ALL THAT APPLY:*

PARENT/GUARDIAN 1PARENT/GUARDIAN 2AGENTGUARDIAN
WHAT PHRASE WOULD YOU LIKE TO USE FOR PICKING UP YOUR CHILD?*
PROPOSED DURATION AT ROSSALL?*
E.G. 2 YEARS
PLEASE INDICATE HOW YOU HEARD ABOUT ROSSALL SCHOOL NURSERY?*
PLEASE GIVE DETAILS:*
PLEASE DETAIL THE NAMES OF ANY SIBLINGS ATTENDING ROSSALL OR REGISTERED FOR ENTRY, OR ANY OTHER CONNECTION WITH ROSSALL:*
IF NONE, PLEASE STATE 'N/A'
HAVE YOU VISITED ROSSALL BEFORE?*

YESNO
WHEN DID YOU VISIT?*
E.G. JANUARY 2020

DOCUMENT UPLOAD
PLEASE UPLOAD A COPY OF YOUR CHILD'S BIRTH CERTIFICATE:*

Cancelof
PLEASE UPLOAD A COPY OF YOUR CHILD'S PASSPORT:

Cancelof
PLEASE UPLOAD A COPY OF PARENT 1'S PASSPORT: (a parental passport is required if the child does not yet have a passport)*

Cancelof
PLEASE UPLOAD A COPY OF YOUR PARENT 2'S PASSPORT:*

Cancelof

DECLARATION
I/ We confirm that the information supplied is complete and true to the best of my/our knowledge. I/We understand that submission of this form does not guarantee a place for my/ our child or the sessions selected above.

I/ We acknowledge that a legally binding contract for nursery and childcare services for my/our child will not be formed until the Nursery has received my/our completed Acceptance Form accepting the offer of place as specified in an Offer Letter.
PARENT/GUARDIAN 1 SIGNATURE*

Clear
PARENT/GUARDIAN 2 SIGNATURE*

Clear
Date Time
REGISTRATION FEE

My Products

Nursery Registration Fee

£50.00

Total

£0.00

	YES	NO
CALPOL
MEDICATION
SUDOCREM
SUNCREAM
EMERGENCY MEDICAL TREATMENT

	YES	NO
To have photographs and videos uploaded to their EYlog online learning journey
Photographs of my child to be displayed in the setting Yes
Photographs of my child to be used on the School website
Photographs of my child to be used on School social media (Facebook, Twitter, Instagram)
My child to participate in outings around the School
My child to travel on the School mini bus around School
My child to interact with the Rossall animals

PARENT(S)/GUARDIAN(S) DETAILS