Registration Form Theale

Registration Form

Theale
Child's name*

First NameLast Name
Date of birth or due date*

DayMonthYear
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:*

I am the only person with parental responsibilitiesParental responsibilitiesPayment of feesCollect child from nurseryContact in emergency
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:

I am the only person with parental responsibilitiesParental responsibilitiesPayment of feesCollect child from nurseryContact in emergency
Any other emergency contacts

Permissions

	YES	NO
Collect child from nursery
Contact in an emergency

Any other emergency contacts

Permissions

	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?

	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?

	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

	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

	Full Day
Monday
Tuesday
Wednesday
Thursday
Friday

Preferred start date

DayMonthYear
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)
Do you require a place for term-time only
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

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Date

DayMonthYear
Date
Parent / Carer 2

First NameLast Name
Signature

Powered by Jotform SignClear
Date

DayMonthYear
Date
How did you hear about Tigers day Nurseries?*

FacebookWebsitewww.daynurseries.co.ukFriendInstagram,NewspaperGoogleSibling attendsOther
Does a sibling attend or has attended the nursery?*

YESNO
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*

Registration Fee

£75.00 Quantity

Total

£0.00

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Should be Empty: