WMS Admission

2. CHILD INFORMATION
Signature boxes MUST be signed by a Parent/Guardian and witnessed by the Service Manager or Designated Person in Charge.
Full NAME of CHILD *
DATE of BIRTH *

Month Day Year
Date
AGE in years *
Home ADDRESS *
(please notify management if address changes)
Parent/Guardian Name 1 *

First Name Last Name
Relationship to child *
Mobile Number *
Address (if different to above):
Home Number
Work Number
Email *
example@example.com
Parent/Guardian Name 2
Relationship to child
Mobile Number
Address (if different to above):
Home Number
Work Number
Email
example@example.com

3. MEDICAL INFORMATION
Who may be contacted in an EMERGENCY if parents/guardians are uncontactable or unavailable?
EMERGENCY CONTACT Name *
Relationship to child
MOBILE Number
HOME Number
WORK Number
ADDRESS
CHILD’S GP/ FAMILY DOCTOR
DOCTOR'S NAME
PRACTICE ADDRESS
CONTACT NUMBER
MEDICAL HISTORY (Please outline any medical conditions your child may have, example: asthma, eczema, immunodeficiency)
NOTE: Medical Care Plans may be required. Parents/Guardians will be asked to collaborate in the forming of care plans.

In the case where your child has an immunodeficiency, you may be asked to complete a Compromised Immunity Form with us as part of a COVID-19 Risk Assessment and help us form an individual care plan for your child ahead of attending our care setting.
Does your child have any known ADDITIONAL NEEDS?

Yes No
Note: You may be required to complete separate care plans in respect of your child relating to their additional need.
Does your child have any known ALLERGIES?

Yes No
If YES, please complete the following form
What is the child Allergic to?
What is the nature of the Allergic Reactions? (ex: anaphylactic shock reaction, rash, vomiting, reddening of skin, swelling, breathing problems etc.)
IMMEDIATE ACTION to be taken should Allergic reaction occur? (example, Epipen)
Is Medication Used to treat Allergic Reaction? (example, Antihistamine? Ventolin?)
PREVENTION OF CONTACT WITH ALLERGEN - What Control Measures can be put in place to minimize risk of contact?
Other Notes/Comments
To be filed in the child's records and be available to staff via ALLERGY ALERT ID SIGN & INFO in an appropriate area in the relevant care space. Induction on storage and administration of any allergy-related medicines (inc. Epipen) to be provided to all staff ahead of the child's commencement in the care setting.
PRESCRIBED MEDICATION

Parents/Guardians must sign and complete a Medication form before Prescribed Medication is administered. Prescribed Medication must clearly state child's full name, dosage, route of administration, date and expiry date. We can only accept medicine that has the original pharmacy label and is written in the English language.

AGREEMENT FOR MEDICAL TREATMENT
I hereby give consent to my child child name receiving medical treatment in the case where a doctor considers it required as an emergency and I cannot be contacted following reasonable attempts to do so prior to such treatment being administered. In the event of an emergency an ambulance will be called.
Parent/Guardian Signature *

Clear
Date

Month Day Year
Date
Witnessed
Date

Month Day Year
Date
AGREEMENT FOR ANTI FEBRILE MEDICATION

The service will only administer 'Calpol' (paracetamol) or Nurofen (Ibruprofen) if a child becomes unwell and has high temperature of 38°C or over that does not begin to decrease under close supervision within a period not exceeding 10 minutes. If a child has a high temperature the parent/guardian will be contacted before staff administer the temperature reducing medication and they will be asked to arrange to collect the child promptly. In the case where the service is unable to make contact with the parent/guardian within the 10 minutes of temperature supervision checks, Anti-febrile medication (Example, Calpol, 2 months +) will be administered by a designated person to the child where the below signature is provided.
I confirm that. to my knowledge. *

My child DOES have an Allergy to anti-febrile medication (Calpol/Nurofen) My child DOES NOT have an Allergy to anti-febrile medication (Calpol/Nurofen)
I herebyGive consent/Do not give consent* to Child Name* to receive anti-febrile medication in the event of a high temperature.
Parent/Guardian Signature *

Clear
Date *

Month Day Year
Date
Witnessed
Date *

Month Day Year
Date

6. AUTHORISED COLLECTION
6. AUTHORISED COLLECTION
AUTHORISED COLLECTION PERSON 1
Relationship to child
MOBILE Number
ADDRESS
HOME Number
WORK Number
AUTHORISED COLLECTION PERSON 2
Relationship to child
MOBILE Number
ADDRESS
HOME Number
WORK Number
AUTHORISED COLLECTION PERSON 3
Relationship to child
MOBILE Number
ADDRESS
HOME Number
WORK Number
Parent/Guardian Signature *

Clear
Date

Month Day Year
Date
Witnessed
Date

Month Day Year
Date
Separated and Divorced Parents

Married parents are automatically joint guardians of their children. Neither separation nor divorce changes this. By law, an unmarried mother is the automatic guardian of a child born outside of marriage. In some circumstances, unmarried fathers have automatic access. The service should be informed about access rights. Unmarried fathers will automatically become guardians of their children if they meet a cohabitation requirement. An unmarried father who cohabits for 12 months with the child's mother, including 3 months following a child's birth, will automatically become the child's guardian. This provision is not retrospective, so guardianship will only be acquired automatically where the parents live together for at least 12 months (applies to children born after 18 January 2016

We cannot refuse either parent to collect their child unless a court order is in place.

We ask that parents/guardians give us information on any person that does not have legal access to the child.

Where custody of a child is granted to one parent, we would ask you to clarify the circumstances with us. This information will remain confidential and will only be made known to the relevant staff. If there is any legal documents i.e. custody order, barring order in place, we would ask you to provide us with a copy to keep on your file. This will be returned to you whenever care for your child ceases.
7. ATTACHMENT CHECKLIST
Please ensure the following are attached
- Copy of immunisation record (Immunisation Passport or GP Print-out)
- Signed COVID-19 Child & Parent Forms (All parents/guardians must confirm receipt of service's COVID Policy Response Plan
- Photo of child, Parent/Guardian and other collectors (where applicable)
And if applicable:
- Medical Emergency Care Plan (such as Allergy)
- Other Care Plans (Compromised Immunity or AdditionalNeeds)
- Any relevant Doctor / Consultant Notes

8. ‘ALL ABOUT ME’ (OPTIONAL)
We believe it is important to know as much as we can about a child before they start our service. Completion of the following section of this registration form is optional for parents and guardians, but we believe it helps us to get to know the child and helps settle a child into the service if we know things about them.
Does your child have any brothers or sisters? (Please indicate their ages)
What are the names (or nicknames) of other familymembers and other significant people close to thechild? (ex. Minders)
Do you have any household pets?
What languages are spoken at home?
What is your child’s favourite food? Any restricted foods or dietary needs/preferences?
Has your child attended any previous care settings or playgroups?
Does your child have any particular play interests at the moment, or particular toys, characters, books, songs/rhymes he/she likes?
What other things does your child show interest in or talk about?
How do you usually comfort your child when he/she is upset? (Is a soother routinely used?)
Do you have any concerns or worries about your child's development?
Is there any other relevant information you would like us to know about your child?
(Example: Their religion, any relevant personality or temperament traits, any fears etc)

9. DATA CONSENT
Data Privacy - Consent for Collection and Usage of your personal data

Please ensure that all parents or guardians whose information has been supplied in this form read and complete the following.

I have read the Service's Privacy Notice, and I understand the reasons for requesting the personal information sought about myself and my child in this Registration form.

I consent to the collection and processing of the data given, for these sole purposes, by [Service name]

I understand that I can request a copy of this information, and revise or withdraw my consent by contacting the service at any time.
Parent/Guardian Signature 1 *

Clear
Date

Month Day Year
Date
Parent/Guardian Signature 2

Clear
Date

Month Day Year
Date
Manager's Signature

Clear
Date

Month Day Year
Date
Should be Empty:

CHILD REGISTRATION FORM

1. BOOKING INFORMATION

2. CHILD INFORMATION

3. MEDICAL INFORMATION

4. IMMUNISATION

5. PERMISSION

6. AUTHORISED COLLECTION

6. AUTHORISED COLLECTION

7. ATTACHMENT CHECKLIST

8. ‘ALL ABOUT ME’ (OPTIONAL)

9. DATA CONSENT