Start Date at Bambi's (if you are applying for a future term, please enter the date of the first Monday of that term, e.g. 1st Monday in September)
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Service Registration Form
Under the Early Years Services Regulations (2016), Bambi’s is required to have specific information on your child, their family and emergency contacts, and their interests as this information will help with the settling in process and the care of your child. Bambi’s Data Protection Policy and Privacy Notice outlines how we store, access and dispose of personal data.
I/we acknowledge that Bambi's is required to hold details and information on my child and our family. I am aware this is a requirement under the Early Years Services Regulations (2016). I have read and received a copy of the Privacy Notice and I will inform Bambi's of any details which change during the course of my child's time with the service. I/we consent to the processing of data given in this form.
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Child Details
Which service are you registering for?
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ECCE
ECCE + Additional Hours
Summer Camp
October Mid-Term Camp
Easter Camp
After School Service
Before School Service
NCS
OTHER (non-ECCE)
Child name
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First Name
Last Name
Date of Birth
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Day
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Month
Year
Date
Gender
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Please Select
Male
Female
First spoken language
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e.g. if the child speaks a language other than English at home, please let us know here
Address
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Street Address
Street Address Line 2
Town
County
Eircode
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Parent 1
Parent 1: Name
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First Name
Last Name
Parent 1: Primary Language Spoken
e.g. French
Parent 1: Relationship to Child
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Please Select
Mother
Father
Foster Parent
Legal Guardian
Other
Parent 1: Email Address:
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Email
Parent 1: Mobile Phone Number:
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e.g. 087 123 4567
Format: 000 000 0000.
Please acknowledge that you will be added to the relevant Parent WhatsApp group
Yes, I acknowledge that I will be added to the relevant WhatsApp group (recommended)
No, I do not have WhatsApp / only want notifications by email
Does Parent 1 live at the same address as the child?
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Yes
No
Parent 1: Address
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Street Address
Street Address Line 2
Town
County
Eircode
Parent 1: Name of Workplace
Parent 1: Workplace Address
Street Address
Street Address Line 2
Town
County
Eircode
Parent 1: Workplace Landline Phone Number
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Area Code
Phone Number
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Parent 2
Parent 2: Name
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First Name
Last Name
Parent 2: Relationship to Child
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Please Select
Mother
Father
Foster Parent
Legal Guardian
Other
Parent 2: Email Address:
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Email
Parent 2: Mobile Phone Number:
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e.g. 087 123 4567
Format: 000 000 0000.
Does Parent 2 live at the same address as the child?
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Yes
No
Parent 2: Address
Street Address
Street Address Line 2
Town
County
Eircode
Parent 2: Name of Workplace
Parent 2: Workplace Address
Street Address
Street Address Line 2
Town
County
Eircode
Parent 2: Workplace Landline Phone Number
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Area Code
Phone Number
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Emergency Contact Person 1
This should be someone, other than parents, who are contactable in the event of an emergency where parents are unavailable
Emergency Contact Person 1: Name
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First Name
Last Name
Emergency Contact Person 1: Relationship to Child
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Please Select
Parent
Aunt/Uncle
Older Sibling
Grandparent
Childminder
Other
Emergency Contact Person 1: Phone Number:
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e.g. 087 123 4567
Format: 000 000 0000.
Emergency Contact Person 1: Address
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Street Address
Street Address Line 2
Town
County
Eircode
Data Consent - Emergency Contact Person 1
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I have informed this person that their contact details are held on file by Bambi's Childcare Limited
The Emergency Contact Person 1 listed above is also authorised to collect my child when I/we are unavailable:
Yes
No
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Emergency Contact Person 2
Emergency Contact Person 2: Name
First Name
Last Name
Emergency Contact Person 2: Relationship to Child
Please Select
Parent
Aunt/Uncle
Older Sibling
Grandparent
Childminder
Other
Emergency Contact Person 2: Phone Number:
e.g. 087 123 4567
Format: 000 000 0000.
Emergency Contact Person 2: Address
Street Address
Street Address Line 2
Town
County
Eircode
Data Consent - Emergency Contact Person 2
I have informed this person that their contact details are held on file by Bambi's Childcare Limited
The Emergency Contact Person 2 listed above is also authorised to collect my child when I/we are unavailable:
Yes
No
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Person 1 who is Authorised to Collect my Child (other than parents)
Authorised Person 1: Name
First Name
Last Name
Authorised Person 1: Relationship to Child
Please Select
Parent
Aunt/Uncle
Older Sibling
Grandparent
Childminder
Other
Authorised Person 1: Email Address:
Email
Authorised Person 1: Phone Number:
e.g. 087 123 4567
Format: 000 000 0000.
Does Authorised Person 1 live at the same address as the child?
Yes
No
Authorised Person 1: Address
Street Address
Street Address Line 2
Town
County
Eircode
Data Consent - Person 1 Authorised to Collect my Child
I have informed this person that their contact details are held on file by Bambi's Childcare Limited
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Person 2 who is Authorised to Collect my Child (other than parents)
Authorised Person 2: Name
First Name
Last Name
Authorised Person 2: Relationship to Child
Please Select
Parent
Aunt/Uncle
Older Sibling
Grandparent
Childminder
Other
Authorised Person 2: Email Address:
Email
Authorised Person 2: Phone Number:
e.g. 087 123 4567
Format: 000 000 0000.
Does Authorised Person 2 live at the same address as the child?
Yes
No
Authorised Person 2: Address
Street Address
Street Address Line 2
Town
County
Eircode
Data Consent - Person 2 Authorised to Collect my Child
I have informed this person that their contact details are held on file by Bambi's Childcare Limited
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Medical Information
Name of Child's GP
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First Name
Last Name
Surgery Name
e.g. Clondalkin Medical Practice
Address of GP Surgery
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Street Address
Street Address Line 2
Town
County
Eircode
GP Surgery Landline Phone Number
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Area Code
Phone Number
GP Surgery Email Address:
Email
GP Surgery Alternative Phone Number:
e.g. 087 123 4567
Format: 000 000 0000.
Medical Needs
To support your child, it is important that we know if he/she has any of the following:
Medical Conditions
Additional needs e.g. physical / intellectual
Hearing / Speech difficulties
Allergies to food, medicine orother pollutants
Specific cultural / dietary requirements
Other
If "Yes" to any of the above questions, please provide details
If needed, a specific care plan will be developed for your child. Please upload any relevant additional information.
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Immunisation Records
Please indicate the vaccination status of this child:
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Rows
Has been Received
Date Received
Due to receive / Will not receive
6-in-1
Due to Receive
Will not Receive
PCV
Due to Receive
Will not Receive
Men B
Due to Receive
Will not Receive
Rotavirus
Due to Receive
Will not Receive
Men C
Due to Receive
Will not Receive
MMR
Due to Receive
Will not Receive
HIB
Due to Receive
Will not Receive
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Medical Consent
The Early Years Services Regulations (2016) requires parental/guardian consent for appropriate medical treatment should the need arise. Parents will always be asked to complete a medical consent administration form prior to prescription medicines being given in Bambi’s.
Emergency Medical Treatment: I give my permission for my child to receive appropriate medical treatment in the event of an emergency as outlined in Bambi’s policies
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Yes
No
Temperature Reducing Medication (Antipyretic / Anti-Febrile Medication): In the event where parents/guardians cannot be contacted, I give permission for my child to receive temperature reducing mediation as outlined in Bambi’s administration of medication policy
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Yes
No
To the best of my knowledge, my child is...
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Not allergic to temperature control medication, e.g. Calpol
Allergic to temperature control medication e.g. Calpol
Sun Cream Permission: I give permission for sun cream supplied by Bambi’s to be applied to my child
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Yes
No
I will notify Bambi’s as soon as possible: if my child is diagnosed with an infectious disease e.g. measles, viral meningitis, diphtheria, whooping cough, COVID-19. regarding any prescription medication for my child if there are changes to any of the details contained on this form I have read Bambi’s Policies & Procedures relating to medical care. I understand the above and have consented/not consented to the treatment for my child.
Signature
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Date Signed
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Other Parental Consent
Permission for photographs / video within Bambi’s: During the school year we will be taking photos of the children at work and any events happening at Bambi’s to display around the room. Also, parents/guardians are allowed to take photos/video of their child’s birthday party and other events, which means your child may be in another parent’s photo/video. Do you consent?
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Yes
No
Permission for local outings: I give permission for my child to go on local outings with Staff. Do you consent?
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Yes
No
Permission for photographs / video at local outings: I give permission for pictures to be taken and shared with other parents on these outings
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Yes
No
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Help us get to know your child
To help your child settle in, we need to get to know him/her, their family and the things which are important in their life. You know your child best, and we would love for you to share some of their stories and interests. This information will be shared with the educator working with your child.
Who does your child live with?
Name of family members and others who have a close personal relationship in your child’s life?
What interests does your child have?
What makes your child laugh?
Can you give us suggestions to comfort your child if they become upset?
Are there any special words or phrases which your child uses that we need to know?
Is there anything in particular that may frighten or distress your child? e.g. clowns, spiders
Are there any occasions/celebrations that you would like us to celebrate? e.g. birthdays, religious festivals, cultural festivals
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Birth Cert
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Please upload a clear photo of your child's birth certificate. If using your mobile phone, you can use your camera to take a photo.
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PPSN Proof
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Please upload a photo of an official document with the PPSN clearly visible. Youl will find this on the GP under 6's card, or on a letter sent to you by the Government to advise you of the PPSN. If using your mobile phone, you can use your camera to take a photo. This image will be destroyed by Bambi's under the relevant Data Protection legislation, as soon as he/she is registered.
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Before School & Afterschool Service
What class is your child attending?
Teacher name:
Room Number
School Collection time (for Afterschool only, leave blank for Before-School)
Time
Parent collects from Bambi's at (for Afterschool only, leave blank for Before-School)
Time
Days the service is required
Monday
Tuesday
Wednesday
Thursday
Friday
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Policies & Procedures Acknowledgement
I have read and agree to abide by the Policies & Procedures of Bambi’s, a copy of which is available on the premises. Signature:
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Date Signed
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Year
Date
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