Registration Form

Child's name *

First NameLast Name

Child's Date of Birth:*

Date

Child's age on start date: *

Ethnicity:*

Parent / guardian name (1) :*

First NameLast Name

Email*

Phone number :*

Address*

Street Address

CityBorough

Postcode

Work Address:*

Company name

Address

CityBorough

Post Code

Work phone number :*

Parent / guardian name (2) :*

First NameLast Name

Home Address:*

Street Address

Street Address Line 2

CityBorough

Postcode

E-mail*

Phone Number *

Work Address:*

Company Name

Street Address

CityBorough

Postcode

Please specify the days and sessions you would like to book, and we will respond as soon as possible to confirm your reservation or suggest alternatives. If the requested sessions are fully booked, my child's name will be placed on a waiting list for a later entry. I also acknowledge that the session fee may increase each April and may vary in other months as well.

The fees are on our website at www.littlestarsn16.co.uk/registrationandfees, or you can request this information by emailing us at littlestars2012@yahoo.co.uk.

To book your child's nursery sessions, we require a minimum of 2 full days for 15 funded hours, and a minimum of 3 full days for 30 funded hours. These days must include either Monday or Friday.*

	Full day 8am till 6pm
Monday
Tuesday
Wednesday
Thursday
Friday

Does your child have any allergies, special educational needs, has your child got EHCP or disabilities we need to be aware of? ( Please be aware that we require written doctor confirmation/diagnosis if your child has any dietary allergies): *

Is your child entitled to Government Childcare funded hours ? This could be 15 or 30 hours?*

Please send us the eligibility code and parent NIN which you use to apply for the funded hours

Is your child on child protection plan or a child in need plan?*

When would you like your child to start? We will contact you with an alternative date if we cannot start your child on the date you have chosen.*

Date

Please give us emergencies contact numbers of any three people who we can contact if we can't contact any of the parents/guardians: Prefebly people who live short distance to the nursery and will be able to get to us withing 30 min to an hour. *

	Full Name	Address	Contact Number	relationship to the child
1
2
3

How did you hear about us?*

Other*

Will you be willing to recommend us?*

YesMaybeNo

The Nursery will confirm in writing the availability of the requested sessions. You will then receive a Nursery Entry form to complete and return to the Nursery closer to the entry time.

I/We understand and agree that fees for pre-booked sessions must be paid in advance every month. We acknowledge that fees must be paid in full for any absences related to child illnesses or holidays. Additionally, fees will be charged if the Nursery is forced to close due to unforeseen emergencies or governmental directives.

I/We understand and agree that if I wish to withdraw my child from Little Stars Nursery, the deposit will be forfeited to cover administrative fees and costs associated with finding a replacement.

I/We understand and agree that if I have secured a place for a later date, I must provide written notice six weeks in advance if I no longer require the place. Failure to do so will result in a fee equal to the placement deposit being charged.

I/We understand and agree that in the event of an accident during the Nursery day, staff will make every effort to contact a parent or guardian. If this is not possible, I/We give permission for the staff to administer any immediate treatment that may be necessary for my/our child by a member of the team, a doctor, or a local hospital, whichever is most appropriate.

Parent / Guardian Signature*

Signature / Guardian Signature

Registration form: