Student Registration Form

LITTLE CHAMPIONS NURSERY

Villa 22 St 81a Jumairah , Dubai

info.littlechampionsnursey@gmail.com

www.littechampionsnursery.com

971 - 43461297
Student Registration Form

2024-2025

Basic Information
Child Full Name*

First NameMiddle NameLast Name
Religion*
Gender*

MaleFemaleN/A
Place of Birth*
First Language*
Birth Date*

MonthDayYear
Nationality ( as in passport)*
Child Passport *

File should be in pdf, doc/docx format,jpg, jpeg, png, gif
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Child Emirates ID ( Front and Back )

File should be in pdf, doc/docx format,jpg, jpeg, png, gif
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Child Birth Certificate *

File should be in pdf, doc/docx format,jpg, jpeg, png, gif
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Mother Name*

First NameLast Name
Nationality*
Dubai Phone Number*
Email*
example@example.com
Mother's Work Number
Mothers Employer and Profession
Mother Emirates ID ( Front and Back )

File should be in pdf, doc/docx format,jpg, jpeg, png, gif
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Mother Passport *

File should be in pdf, doc/docx format,jpg, jpeg, png, gif
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Father Name

First NameLast Name
Nationality
Email
example@example.com
Dubai Phone Number
Father Passport

File should be in pdf, doc/docx format,jpg, jpeg, png, gif
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Father Emirates ID ( Front and Back )*

File should be in pdf, doc/docx format,jpg, jpeg, png, gif
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Present Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Medical Information :
I confirm that all the above medical information is accurate to the best of my knowledge. I will endeavor to provide Little Champions Nursery with any changes to this information, keeping the nursery file up to date at all times.

Pleaser mark if your child had the following illnesses/conditions.*

	Yes	No
Tonsilitis
Frequent colds
Infective Hepatitis
Pneumonia
Mumps
Poliomyelitis
Diabetes
Asthma
Tuberculosis
Epilepsy
Polio
Heart Conditions

Other Medical Condition ( Specify)
Has your child received any kind of learning or behaviour support and/or experienced any learning difficulties?*

YesNo
If so, please provide details below
Family History*

DiabetesTuberculosisStrokeNoneHypertensionOther
Please specify allergies or food restrictions and special medical attention if any:*
Is there any restriction in your child's physical activity?*

YesNo
If yes, please provide details.
Any further information that may be helpful in the care of your child.
I authorise Little Champions to administer the following medication/products according to manufacturer/physician's written instructions should it be required. Other medication may be administered as required, subject to my sign off on the Medicine Administering Form available in the office. I will not hold Little Champions liable for any allergic reactions or other symptoms when the medication/products are used in accordance with these terms.*

ParacetamolFirst Aid OintmentInsect Bite CreamAll of the above
Immunisation

The Department of School Health requires that the nursery maintain each child's immunisation history. Please email a copy of your child's immunisation records
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Emergency Contact*

First NameLast Name
Relationship
ex. Father, Mother, etc.
Phone Number Of Person To Contact In Case Of Emergency*
Please enter a valid phone number.
Authorization

Please read the Little Champions Nursery terms and conditions:
I agree to my child receiving emergency medical treatment in case the parents or guardian cannot be reached.*

YesNo
I agree for my child to participate in face painting activities held at the nursery.*

YesNo
I agree for my child to participate in water-based activities held at the nursery.*

YesNo
I give permission for photographs and videos of our child and/or of myself to be taken which maybe used for marketing material or nursery newsletters. I understand I have no ownership of any photographs or videos that maybe taken:*

YesNo
I give permission for photographs taken of my child to be used internally for nursery newsletters:*

YesNo
All terms and conditions in this agreement are confidential. In the case of any breach Little Champions Nursery reserves the right to make amendments to the terms and conditions of your childcare contract. I agree to the conditions of enrollment as outlined in the Little Champions Nursery Parent Contract, which includes but is not limited to general information, payments, fines and withdrawal policy. I have read and understood this contract is deemed valid for the duration of the child’s enrollment at Little Champions Nursery.*

Yes
I hereby declare that the information provided as well as supporting documents are true.*

Agree
Signature*

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Student Registration Form

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