Lionheart Christian Nursery Registration Form

New Student Registration Form

Welcome! You can register a new student by providing child details, parent/guardian information, emergency contacts, medical information, attendance preferences, permissions, and final declaration.
Child Details
Child Surname
Child Forenames
Child Age
Child Sex
Child Date of Birth

MonthDayYear
Date
Child Ethnicity
Child Home Language
Child Country of Birth
Child Nationality
Previous Setting Name
Previous Setting Date Attended
Previous Setting Telephone Number
Please enter a valid phone number.Format: (000) 000-0000.
Mother/Guardian Details
Mother/Guardian Full Name

First NameMiddle NameLast Name
Mother/Guardian Home Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Mother/Guardian Postcode
Mother/Guardian Date of Birth

MonthDayYear
Date
Mother/Guardian NI Number
Mother/Guardian Mobile Number
Please enter a valid phone number.Format: (000) 000-0000.
Mother/Guardian Work/Home Phone
Please enter a valid phone number.Format: (000) 000-0000.
Mother/Guardian Email
example@example.com
Mother/Guardian Religion
Mother/Guardian Occupation
Father/Guardian Details
Father/Guardian Full Name

First NameMiddle NameLast Name
Father/Guardian Home Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Father/Guardian Postcode
Father/Guardian Date of Birth

MonthDayYear
Date
Father/Guardian NI Number
Father/Guardian Mobile Number
Please enter a valid phone number.Format: (000) 000-0000.
Father/Guardian Work/Home Phone
Please enter a valid phone number.Format: (000) 000-0000.
Father/Guardian Email
example@example.com
Father/Guardian Religion
Father/Guardian Occupation
Emergency Contacts

Please supply three emergency contacts, This can be done by clicking the 'Add contact' button for the creation of more fields.
Emergency contacts
Health / Medical & Additional Needs
Child Dietary and Allergy Information
Child Medical Information
Child Physical Disability Details
Health Visitor Name
Health Visitor Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Health Visitor Telephone Number
Please enter a valid phone number.Format: (000) 000-0000.
Medical Consent (Calpol)
Consent for Calpol
Calpol Consent Parent/Carer Signature
Calpol Consent Date

MonthDayYear
Date
Place Type & Attendance Pattern
FULL-TIME FEE PAYING PLACES

We have full fee-paying places available for children of all ages.

Feepaying places are also available for families who may wish to top up part timeplaces to full-time places. T

The fees are as follows:
- £320.00 per week – [Monday to Friday | 8am to 6pm]
- £64.00 per day – [Full Day | 8am to 6pm]
- £32.00 per morning – [Half Day | 8am to 1pm]
- £32.00 per afternoon – [Half Day | 1pm to 6pm]
- Additional session - £15 per hour Fees are payable on or before the 1st day your child attends each week.
FREE 15 AND 30 HOURS PER WEEK PROVISION

My child will be attedning for 15/30 hours per week on the following days:

Rows	Mon	Tues	Wed	Thurs	Fri
Mornings: 8:00am - 1:00am
Afternoons: 1:00pm - 6:00pm
Additional Sessions
Full Time Fee Paying Place

Use of Information & Permissions
Consent for use of information
Agreement to Withdrawing a Child Policy
Final Declaration
Final Parent/Carer Signature
Final Signature Date

MonthDayYear
Date
Should be Empty:

New Student Registration Form

Child Details

Mother/Guardian Details

Father/Guardian Details

Emergency Contacts

Health / Medical & Additional Needs

Medical Consent (Calpol)

Place Type & Attendance Pattern

Use of Information & Permissions

Final Declaration