Registration Form

Registration Form
Section 1 - Child's Details
Which of our nurseries are you applying for?

Abercorn (South Queensferry)Fordell Firs (Dunfermline)
Have you attended a show round or open evening?

YesNo
Child's Full Name

First NameLast Name
Known as
Child's Date of Birth

DayMonthYear
Date
Gender

MaleFemale
Child's Home Address

Street Address

Street Address Line 2

Town/CityCounty

Post Code
Desired Start Date

DayMonthYear
Date
Section 2 - Emergency Contact Details
Name

First NameLast Name
Contact Number

Area CodePhone Number
Email
example@example.com
Relationship to Child
Lives at the same address as childCan collect child
Name

First NameLast Name
Contact Number

Area CodePhone Number
Email
example@example.com
Relationship to Child
Lives at the same address as childCan collect child
Section 3 - Sessions Requested

Please state exactly which sessions you require (minimum attendance of 15 hours per week)
Are you looking for a term time or full year space at Little Bugs?

Term time (closed for all local council holidays and in-service days)Full year (closed for two weeks at Christmas and Little Bugs in-service days)

	8am - 1pm (morning session - full year only)	8am - 4pm (short day- full year only)	8am - 6pm (full day - full year only)	9am - 3pm (term time only)
Monday
Tuesday
Wednesday
Thursday
Friday

FUNDED ENTITLEMENT: Children of an eligable age are currently entitled to 1140 hours of Early Learning and Childcare funding per year. Little Bugs parents can choose to use this funding flexibly for either full or half day provision. Little Bugs is open 50 weeks of the year, therefore eligable children have 22 hours and 50 minutes per week to use at Little Bugs. Parents can choose to pay for additional hours. Please note that parents will be eligible to give 4 weeks notice if they wish to withdraw or change their child's funding. If the fees cannot be claimed from the Local Authority it will be the responsibility of the parents/guardians to reimburse Little Bugs Ltd.
How many hours of funding would you like to use with Little Bugs each week?
Is your child on a split placement with another Nursery?

YesNo
Which primary school do you intend to enrol your child to?
Section 4 - Medical/Health Information

Please provide details of any medical conditions of which the nursery team should be aware (e.g. asthma, allergies, eyesight/hearing problems, speech therapy. epilepsy etc.)
Does your child have any medical conditions, disabilities, allergies, additional support needs or receive regular medication?

YesNo
If yes, please provide details:
Doctors Surgery
Phone Number

Area CodePhone Number
Address

Street Address

Street Address Line 2

Town/CityCounty

Post Code
Name of Health Visitor

First NameLast Name
Health Visitor Contact Number

Area CodePhone Number
Are there any other professionals currently involved with the child (e.g. Social Worker, Educational Psychologist, Speech and Language therapist)?

YesNo
If yes, please provide details:
Do you give permission for staff to apply sun block/midge repellent to your child if deemed necessary?

YesNo
Do you need to provide information relating to religion e.g. observance of religious festivals or prohibited foods?

YesNo
Does your child have any non medical dietary requirements e.g. vegan, vegetarian, no e numbers?

YesNo
If yes, please provide further details:
Section 5 - Ethnic Background

You are not required to complete these questions, however the information is extremely valuable as it is used to ensure equal opportunities are offered to all children.
Child's First Language
Child's Ethnic Origin
Section 6 - Any Other Relevant Information
Please provide details here:
Section 7 - Permissions
I declare my child medically fit to participate in Little Bugs outdoor activities both on and off site. I undertake to notify Little Bugs Nursery in the event of any change to my child's health. I understand that there is an element of risk involved in taking part in outdoor activities and I accept the risk. In the case of an incident, I give Little Bugs Nursery personnel the authority to administer any first aid treatment considered necessary to preserve my child's life. I agree to emergency medical, surgical and dental treatment being administered to my child, as considered necessary by professional medical authorities.

I consentI do not consent
I accept that personal belongings are not covered by Little Bugs insurance and that Little Bugs will not be held liable for damage to or loss of these items.

I consentI do not consent
Photographs and videos are taken during Little Bugs sessions. These will be used in our assessment, evaluation and monitoring processes.

I consentI do not consent
At times these photographs and videos may be used in Little Bugs publicity, publications and on our website, including social media. At times the press may ask to take photographs of the children involved in nursery activities.

I consentI do not consent
I consent to my personal email being added to the Little Bugs Parent mailing list. This list will be used to provide information/updates regarding the nursery, provide induction materials and marketing of upcoming nursery events. At no time will your email given, sold or passed on to a third party without consent.

I consentI do not consent
I understand that I have to give 4 weeks notice to change or terminate my child's space at Little Bugs. I agree I will be liable to pay 4 weeks worth of fees should I choose to withdraw my child from the service.

I consentI do not consent
I have read and accept the Terms and Conditions outlined by Little Bugs Nursery.

YesNo
Signature of Parent/Guardian

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First NameLast Name
Date

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Date
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Registration Form

Section 1 - Child's Details

Section 2 - Emergency Contact Details

Section 3 - Sessions Requested

Section 4 - Medical/Health Information

Section 5 - Ethnic Background

Section 6 - Any Other Relevant Information

Section 7 - Permissions