Nursery Registration Form

Nursery Registration Form

Please fill in all sections below to register a place for your child. Once this is completed, you will be emailed (usually within a week) to confirm a place has been given. The place is not guaranteed with the form alone, you must await a response from the management team. A registration fee of £75 is also payable upon the place being offered.
Child details

Please fill out your child's details below:
Full name*
Gender*

MaleFemale
DOB*
If your child is not born yet, just add their due date
Home address*
Religion*
If no religion is followed, then please state 'none'
Unique password*
This is used if you have informed us that someone different will be coming to collect
Does/has your child attended any other settings?*
Please give details here e.g. pre-school, other nursery etc.
Parent/guardian details

Please fill out your details below:
Parent/Guardian 1 details*
(full name and relationship to child)
Parent/Guardian 1 D.O.B & National Insurance No*
(full name and relationship to child)
Home address*
if different from child, if not then type 'same'
Work address*
Mobile contact number*
Work contact number*
Email address*
Parent responsibilities for parent/guardian 1*

Parent responsibilityPayment of feesCollect child from nurseryContact in an emergency
Parent/Guardian 2 details*
(full name and relationship to child)
Parent/Guardian 2 D.O.B & National Insurance No*
(full name and relationship to child)
Home address*
if different from child, if not then type 'same'
Work address*
Mobile contact number*
Work contact number*
Email address*
Parent responsibilities for parent/guardian 2*

Parent responsibilityPayment of feesCollect child from nurseryContact in an emergency
Ethnicity and Cultural Background
What is your ethnic group?*
If other, please give details
Which language/s do you speak at home? If English isn't your first language, please give more details below*
Other authorised/emergency contacts

We have the safety and well-being of the children in mind at all times and we are sure that you will appreciate that persons known to you are strangers to us. We do need means of identifying those you have authorised to collect your child, can you please ensure the people you are nominating know they are on this form and have agreed to this. We as a setting and especially your child/children key person will be familiar with you but we do not always have the opportunity to meet both parents. This is also true of your nominated emergency contacts and authorised persons. We therefore request that should anyone unknown to us be collecting your child that you inform us in advance and show us a photograph if possible or a brief description to enable us to identify them when they collect your child. Please note: Authorised persons must be over 18 years of age (you can name up to four)
Contact name 1*
Relationship to child*
Address*
Contact number*
Contact name 2*
Relationship to child*
Address*
Contact number*
Contact name 3
Relationship to child
Address
Contact number
Health information

Please fill in details with as much information as possible
Does your child suffer from any of the following (please tick those which apply)*

AsthmaHeart conditionDiabetesSight impairmentHearing impairmentWears glassesEpilepsyKidney/bladder problemsNoneOther
If you have ticked any of the boxes above, please give details here:*
Has your child had all of their recommended immunisations*

YesNoOther
Does your child require any long term medication? e.g. inhaler*

YesNoOther
Long term medication details if applicable:
Does your child have any special dietary needs e.g. religious reasons*

YesNoOther
Does your child have any special dietary needs e.g. religious reasons*

YesNoOther
Special dietary needs if applicable:
Does your child have any known allergies?*

YesNoOther
Please give details of allergies:
Name of GP practice *
GP address*
GP telephone number*
Safeguarding Children

Please fill out the details below detailing any involvement with a family social worker
Does your family have a social worker for any reason?*

YesNoOther
If you answered yes to the question above, please fill in more details
include social worker name, contact and reasons for their involvement
Health Visitor

Please fill out the details below as best you can. We have a legitimate interest in requesting this data as it will assist in providing the necessary care for your child and to allow us to monitor and assess their development
Health visitor name
Telephone number
Based at
Has your child had their 2 year progress check?*

YesNoOther
If so, on what date was this completed?
Special Educational Needs & Disabilities
Does your child have any special needs or disabilities?*

YesNo
Please give details
What (if any) special support will your child require in our setting?
Are there any professionals involved with your child*

YesNo
Please give further details
Include name, agency, role and telephone number of any professionals
Consent

Please read the following permissions and fill in accordingly
Permission for the setting to act in loco parentis

If emergency treatment is required, either whilst your child is on the premises or on an outing (for the duration of your child’s time with us) and the parents or legal guardians cannot be reached immediately, your signature in the space provided below empowers the settings management to exercise their own judgement in calling the doctor/dentist or any other medical professional indicated above or to transport the child to a hospital casualty department by ambulance. Please read and fill in the declaration below, cross out the statement/wording that does not apply, and sign and date this section.
I give consent on my behalf for an anaesthetic to be administered or for any other urgent medical treatment to be given.*

I DO give permissionI DO NOT give permission
I do not give permission and our wishes are as follows:
Other permissions

Please tick below if you consent to the permission for your child. These permissions will also need to be filled out on your Famly profile (a login will be emailed to you once you are registered and you will need to set up your child's profile.)
Please read and tick if you consent*

I consent to my child participating in off-siteoutings as part of daily practice e.g. trips to the park, shops, etcI consent to my child having their photograph taken for use in displays/name pegs, etc within the setting onlyI consent to my child having their photograph taken to be used for publicity purposes – website, flyers, newslettersI consent to my child’s photograph being used in a group on the settings private portal (private Famly app only for our nursery)I consent to my child’s artwork (with theirname) being displayed in the settingI consent to my child’s photograph being used in learning journeys of other children within the settingI consent to my child’s learning journey being shared with Ofsted inspectors and/or as part of audits by the local authorityI consent for the use of barrier creams and teething gel/powders (I will provide these but also consent to the use of nurseries own if not available)
Signature of parent/guardian*

Clear
Session times

Please mark required sessions below:*

	Full Day (7:30am-6:00pm)	Morning Session (7:30am-1:00pm)	Afternoon Session (1:00pm-6:00pm)
Monday
Tuesday
Wednesday
Thursday
Friday

Booking Pattern*
Required start date*

DayMonthYear
We will inform you if this start date and sessions are available via an offer email.
Please add any additional notes on sessions if needed:
Funding details

Please ensure all information is completed (if your child is not yet born or too young to apply, please leave blank).

	If your child is attending for the funded hours, there is also a parent declaration form to complete. Please complete the following:
Eligible parents full name
Parent's DOB
National insurance number
Term time only or stretched hours
Funding code
Date code received

Please read the funding options below and note that Option 3 will be the default option for funding unless you let us know otherwise.
Please click here to complete the Parent Declaration Form. This form must be completed in order for us to claim funding. Failure to complete will result in full payment of fees until funding can be claimed.
Milk (Buttercups 0-1 only)
Formula milk is provided for under 1 year old.

Please select below which milk your child requires.

Cows milk will be provided for all children over 1 year.
Formula milk required
Please specify which formula if 'other' was selected
Parent Handbook, Terms & Conditions & Registration Fee
Please read the Parent Handbook below:
Please read the Terms & Conditions below and tick to confirm:
Registration Fee

There is a registration fee of £75 due with the application. This can be paid in person, via the Famly app or bank transfer. This registration fee will cover any admin, settling in visits and a nursery rucksack (this must be used as your child's only nursery bag.
How did you hear about us?*

Sign/bannerFlyerGoogle/Other search engineFacebookWord of mouthLive nearbyOther
If you were referred by a friend please let us know who, so we can thank them!
Any additional information:
Please upload an image of your child's birth certificate here*

Browse Files
If your child is not yet born, please add a blank photo Cancelof
Parent/guardian signature

Clear
Should be Empty:

Nursery Registration Form

Child details

Parent/guardian details

Ethnicity and Cultural Background

Other authorised/emergency contacts

Health information

Safeguarding Children

Health Visitor

Special Educational Needs & Disabilities

Consent

Session times

Funding details

Milk (Buttercups 0-1 only)

Parent Handbook, Terms & Conditions & Registration Fee