Wonderbloom Registration Form

New Child Registration Form
Please complete this form in full to sign up your child to our setting in Woking.

Please ensure you have had a tour with us before completing this form, if you'd like to book a tour you can do so on our website.

www.wonderbloom.co.uk
Photo of your child

So we can use this for the profile picture internally
Cancelof
Child's Name*

First NameMiddle NameLast Name
Known as
Preferred name
Child's Date of birth or Due Date*

DayMonthYear
Date
Child's Gender*

MaleFemale
Child's Religion*
Ethnic Group*
Languages Spoken*
Please note which languages and their first language and which are spoken at home.
Who I live with at home?*
Mum, Dad, Sister (08.2020) - If siblings, please give date of birth.

Parent/Carer Information

We need to have details of all persons who have Legal Contact and Parental Responsibility. Please note that anyone having parental responsibility/special guardianship of the named child will equally be responsible for the payment of nursery fees.
Parent/Carer 1 Name *

First NameLast Name
Email*
example@example.com
Mobile Number *
Home Number
Work Number
Home Address *
Does the child live with you as their main residence?*

YesNoOther
Do you have parental responsibility?*

YesNo
Occupation*
Work Address
Date of birth*
For funding purposes
National Insurance Number *
For funding purposes
Is there a second parent/carer to add? All parents must be logged please.*

Yes add anotherNo, move to next question

Please skip if you do not have a second parent to add
Parent/Carer 2 Name

First NameLast Name
Email
example@example.com
Mobile Number
Home Number
Work Number
Address
Does the child live with you as their main residence?

YesNoOther
Do you have parental responsibility?

YesNo
Occupation
Work Address
Date of birth
National Insurance Number

Emergency Contact Details

In case of an emergency and we can not get hold of the parents/carers detailed previously, we need to have details of ideally 2 local emergency contacts (friends/family/neighbours). Please ensure you have consent for the individual's details to be shared with us. They must be over 18 years of age. PLEASE NOTE THIS CAN NOT BE PARENTS ALREADY LISTED ON THE FORM.
Emergency Contact 1 : Name

First NameLast Name
Relationship to child?
Mobile Phone
Address
Please make sure this person can reach the nursery within 1 hour
Has permission to collect child?

YesNo
Can be contacted in an emergency?

YesNo
Emergency Contact 2 : Name

First NameLast Name
Relationship to child?
Home Phone
Mobile Phone
Work Phone
Address
Has permission to collect child?

YesNo
Can be contacted in an emergency?

YesNo
Security Collection

We only allow authorised adults to collect your child from the nursery setting. We must receive prior notice from yourself including the details of who is collecting along with a current photograph to help us identify them. Please note, these authorised persons have to be aged 18 years or above and must bring with them a form of ID if we have not met them before. Please provide a security password to be used when your child is being collected by someone other than the parents/carers details above. This must be kept confidential to the family/designated people responsible for collecting the child. We recommend it being one memorable word and not include any personal details (e.g. middle names or date of birth). Authorised adults will be asked for the password before your child is handed over to them.
Security Password

Health & Medical Details
GP Practice Name *
Please add location too (Woking/Byfleet)
Health Visitor Name
Dentist Surgery Name
Does your child have any long term needs regarding medication?
If yes, please provide details below of signs/symptoms, name of medication, how often your child requires it, and any other relevant information. We will contact you more about this.
Does your child have an allergies, confirmed by a health care professional?*

YesNo
Does your child have an dietary needs or cultural preferences?*

YesNo
Does your child have an dietary needs or cultural preferences?*

YesNo
Please tell us more about your child's diet or allergies, if any.
Is your child up to date with immunisations?*

YesNoNot Immunised

Learning and Development
Does your child currently or have they in the past, attended another childcare setting?
If yes, please give details
Are you happy for us to contact the setting for information on your child to ensure continuity of care?*

YesNoN/A
If so, please provide details (Name, address, contact details, key person)
Does your child have any additional needs?*

YesNo
Please note any additional needs or concerns you have for your child's health or development, plus support in place already
Other professionals involved
Portage, Development Doctor, SLT, Children's Services etc (Full name, role, contact details)

	Morning 8am-1pm	Afternoon 1pm-6pm
Monday
Tuesday
Wednesday
Thursday
Friday

New Child Registration Form

Attendance Details

Parent/Carer Information

Emergency Contact Details

Security Collection

Health & Medical Details

Learning and Development

Permissions