Registration Form Theale

Child's name

First NameLast Name

Date of birth or due date

Date

Address

Street Address

Street Address Line 2

CityCounty

Postcode

Position in family

Religion

Ethnic origin

Nationality

For us to support your child fully, please give details of any additional needs or disabilities

Parent / Carer 1

PrefixFirst NameLast Name

Address

Street Address

Street Address Line 2

CityCounty

Postcode

Home telephone number

Mobile telephone number

E-mail

example@example.com

Work address

Street Address

Street Address Line 2

CityCounty

Postcode

Work telephone number

Work E-mail

example@example.com

Days and hours worked

Responsibilities:

Parent / Carer 2

PrefixFirst NameLast Name

Address

Street Address

Street Address Line 2

CityCounty

Postcode

Home telephone number

Mobile telephone number

E-mail

example@example.com

Work address

Street Address

Street Address Line 2

CityCounty

Postcode

Work telephone number

Work E-mail

example@example.com

Days and hours worked

Responsibilities:

Any other emergency contacts

Permissions

Rows	YES	NO
Collect child from nursery
Contact in an emergency

Any other emergency contacts

Permissions

Rows	YES	NO
Collect child from nursery
Contact in an emergency

Does your child have any allergies?

Does your child have special dietary requirements?

Has your child had any of the following immunisations?

Rows	Immunisation	Date
BCG
Diphtheria
HIB
MMR
Meningitis C
Poliomyelitis
Tetanus
Whooping Cough
Other

Details for any other immunisation

Name of GP

Name of surgery

Surgery telephone number

Surgery address

Street Address

Street Address Line 2

CityCounty

Postcode

Health visitor- If known, please give details

Is your child under the care of any additional services?

Rows	Service
Child protection plan
Child in need plan
Team around the family
Team around the child
Support from Social worker
Support from Family support worker
Other

Provide information and contact details for any of the above services

Permissions

Rows	YES	NO
We/I give permission to seek emergency medical advice and treatment for our/my child
In emergencies, we/I consent to give my/our child Calpol
We/I give permission to put a plaster on my/our child if needed
We/I give permission to apply suncream to my/our child (suncream must be child's own, brought from home)
We/I give permission to apply Sudocrem to our/my child during nappy changes
We/I give permission to take our/my child out on local trips
We/I give permission to use photographs of our/my child around the nursery on displays.
We/I give permission to use photographs of our/my child on our website, Social media, Advertising literature, or any other advertising
Do we have permission to record photographic information on your child's development on their iConnect account and other children within their peer group

Sessions

Rows	Full Day
Monday
Tuesday
Wednesday
Thursday
Friday

Preferred start date

Date

Would you like to go on the waiting list for a funded only place

Is your child eligible for local authority funding

Type in your funding code

Type in the parents National Insurance Number (Required to access free hours)

If we do not have the required session available, would you consider others

Agreement

Please inform us if your family circumstances change after signing, including especially if you separate or divorce.

Please sign to agree that both parents /Carers can have access to your child's records and all information on both parts of the Registration Form are correct.

I agree to abide by the terms and conditions, GDPR Privacy Notice and policies and procedures of Tigers Day Nurseries which I/We have read and fully understand.

All Nursery Policies and Procedures can be found in each nursery, readily available for Parents/Carers to read. If you would like a copy, please do not hesitate to ask.

Parent / Carer 1

First NameLast Name

Signature

Date

Parent / Carer 2

First NameLast Name

Signature

Date

How did you hear about Tigers day Nurseries?

Does a sibling attend or has attended the nursery?

A registration fee of £75.00 is required per family to be placed on the waiting list for a place. This fee is non-refundable and does not guarantee your place. The place is secured with a deposit which we will request in writing once we have your place available.

Registration Fee

£75.00 Quantity

Total

Debit or Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year

Please do not submit this form unless all parents with parental responsibility have signed it.

Registration Form

Registration Fee*

Registration Fee