Poppies Nursery Registration Form

Mother’s Name

First NameLast Name

Mother Phone Number

Please enter a valid phone number.

Mother Email

example@example.com

Father's Name

First NameLast Name

Father Phone Number

Please enter a valid phone number.

Father Email

example@example.com

Child's Name

First NameLast Name

Child's Date of Birth

Date

Child's Passport Photo or Birth Certificate

Address

Street Address

Street Address Line 2

CityCounty

Post Code

Language

First language spoken at home

Religion and ethinicity

ReligionEthnicity

Security collection details. We only allow authorised adults to collect your child with prior notice from you on the day in question. By giving us the details below Poppies Day Nursery assume that you give consent for collection of your child from the named substitutes below. Please give the name, relationship to the child, phone number and password.

What date would you like to start at Poppies?

What days would you like to attend? Please indicate if am / pm / all day

Rows	AM	PM	All day
Monday
Tuesday
Wednesday
Thursday
Friday

Are you eligible for government funding? We offer stretched funding over 52 weeks.

Yes 15 hoursYes 30 hoursNo

If you are eligible for government funding, please provide your eligibility code and your National Insurance number (used for confirmation)

In any case of emergency do we have permission to seek medical advice for your child?

YesNo

Alternative emergency contact if neither parent is available. The latest EYFS reforms advise us that we need 3 emergency contacts. Please give name, phone number, home address and relationship to the child.

Name and phone number of Doctor

Doctor nameDoctor phone number

Doctor address

Any known allergies

Any dietary requirements or intolerances

Any medical conditions, disability or special needs

Is your child up to date with immunisations?

YesNo

Details of any current/ongoing prescribed medication

Names of other professionals involved with your child

Health visitor / Paediatrician / Special Educational Needs Co-ordinator / Dietician

Below are a number of permissions that we need to gain prior to your child starting at nursery. Please ensure you indicate clearly which permissions you are happy to support.

I give permission for photographs of my child to be uploaded to Learning JournalsI give permission for my child’s photograph to be included in group images which will be shared on other pupils’ Learning JournalsI agree that I will not give anyone access to my child’s learning journal or the images availableI agree that I will only use photographs within Learning Journals for my own personal use onlyI give permission for the practitioners at Poppies Day Nursery to take photographs of child for displays within the nursery, newsletters sent via email, and advertising (including the nursery website, posters, leaflets, Facebook Page and nursery prospectus).I give permission for nursery toapply sun cream to my child where necessary using sun cream supplied by thenursery.I give permission for the nursery to take my child on outings to the local area.This includes anywhere which is in walking distance. I understand that any excursions that require an alternative method of transport, further permission will be sought.I give permission for the nursery to give my child emergency Calpol in case of a severe high temperature. I give permission for Piriton to be administered in the case of a bee or wasp sting.

Signature

Your place will is confirmed on receipt of a £150 deposit. £100 will be deducted from your first invoice and £50 is retained for settling in sessions for your child. Please make the transfer of £150 to

Poppies Day Nursery Aldershot

Sort code 20-11-43

Account number 73293971

Where did you hear about us?

Nursery Registration Form

Permissions