LITTLE LEARNERS DAY NURSERY ENROLMENT FORM

EARLY YEARS FUNDING ENROLMENT FORM
BRANCH SELECTION*
REGISTRATION

Please fill in this form in BLOCK CAPITALS, all fields are mandatory, please ensure you complete all sections in full writing n/a where applicable to avoid delays processing your child's enrolment. Your child will not be entitled to claim funding unless you have returned the free entitlement parent/carer agreement form in addition to our own enrolment form.If you decide to cancel your child's place before the agreed start date or at any other time you will be required to give one month's notice. Please provide a copy of your child's birth certificate and proof of address and send your completed form to enquiries@little-learners.net
Child Name

First NameLast Name
Date of Birth

DayMonthYear
Date
Gender

MaleFemalePrefer Not to Say
Address

Street Address

Street Address Line 2

CityCounty

Postcode
Phone Number
Please enter a valid phone number.
Ethnic Origin
Language Spoken at Home
PARENT/CARER INFORMATION
Parent 1 Name

First NameLast Name
Date of Birth

DayMonthYear
Date
National Insurance Number
Email Address
example@example.com
Contact Number
Please enter a valid phone number.
Occupation
Parent 2 Name

First NameLast Name
Date of Birth

DayMonthYear
Date
National Insurance Number
Email Address
example@example.com
Contact Number
Please enter a valid phone number.
Occupation
Which parent holds parental responsibility?*
COLLECTION
Child to be collected from the nursery by the following (unless informed otherwise):
Names of adults who will be collecting your child
Password for collection:
Please chose a password that you will share with any adults who will be collecting your child.
HEALTH INFORMATION
Are your child's immunisations up to date?

YesNo
Does your child have any allergies?
PLEASE NOTE THAT WHILST WE DO NOT HAVE ANY NUT PRODUCTS ON OUR MENU WE CANNOT GUARANTEE THAT SOME PRODUCTS MAY NOT CONTAIN TRACES OF NUTS - SHOULD YOUR CHILD HAVE AN ALLERGY TO NUTS THEN THE PARENT SHOULD SUPPLY FOOD.
Please tick if your child CAN HAVE the following at nursery (please note our meat at nursery is NOT halal).

Cows MilkFishEggsLambChickenBeefPork/Ham/BaconJelly (contains gelatine)
If your child is not allowed to have milk whilst at nursery, is this due to an allergy?

YesNo
Please state any other food not listed above which your child CANNOT have:
Is your child asthmatic?

YesNo
Does your child suffer from febrile convulsions?

YesNo
Does your child suffer from Eczema?

YesNo
If yes on which part of the body?
In an emergency, can CALPOL be given to your child?

YesNo
Please advise of any other medical information that we should be aware of:
SESSIONS

Please tick as appropriate

Please note that whilst we would like to absorb all combinations of days, we would give priority to those requiring five full days.

	Monday	Tuesday	Wednesday	Thursday	Friday
FULL TIME (8:00AM - 6:00PM)
SCHOOL DAY (8:30AM - 3:30PM)
PART TIME (8:00AM-1:30PM)
PART TIME (1:30-6:00PM)
EXTENDED HOURS (7:30AM - 6:30PM)
EXTENDED HOURS (7:30AM - 6:00PM)
EXTENDED HOURS (8:00AM - 6:30PM)

Do you have a 9 Month, 2 Year Old or 30 hours funding code? If yes please provide your code in the relevant box below.

YesNo
9 Month / 2 Year Old Funding Code (if applicable)
30 Hours Funding Code (if applicable)
Are you claiming funding at another setting?

YesNo
If yes, please state the name of the setting:
PLEASE NOTE WE WILL NOT BE ABLE TO CLAIM FUNDING FOR YOUR CHILD UNTIL YOUR NOTICE PERIOD AT YOUR CURRENT SETTING HAS BEEN SERVED.
Expected Start Date:*

DayMonthYear
Date
PRIVACY NOTICE

Here at the nursery we take your privacy seriously and will only use your personal information to manage your account and provide tailored care for your child. We may have to share information about your child with Ofsted or other agencies and other professionals who have a right to see them. We are required to work in partnership with other childcare settings your child may attend and any other professionals or agencies which might be involved with your child. Whilst we will try and let you know in advance that we are going to share information directly with other professionals, there might be some instance(such as safeguarding concerns or an emergency) when this is not possible.I confirm that I have read the prospectus and I agree to abide by the regulations outlined in it. I understand that one calendar month's notice of leaving in writing is required.
Signature*

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Full Name of Signature

First NameLast Name
Date

DayMonthYear
Date

FUNDING
Absenteeism
If your child is absent from the Nursery due to family holidays, sickness or any other reason FULL PAYMENT IS REQUIRED AND NO REFUNDS CAN BE GIVEN. We cannot swap sessions or days. Fees are due in advance and for the duration of any holidays. We are open 51 weeks of the year, so full fees are payable throughout school holidays.

Statutory Holidays and Matters Out Of Our Control
Payment will be required in full for two staff training days per annum, Bank holidays and statutory holidays. The nursery will be closed from 12.30pm on Christmas Eve. You are not charged for one week between Christmas and New year as monthly fees are calculated on 51 weeks, if you are a weekly payer then please do not pay for this week. Payment is required in full should we be prevented to open the nursery due to extreme weather conditions, acts of god or other matters which are totally out of our control.

Notice of Leaving or Reduction in Sessions
One calendar month’s notice in writing or one month’s fees in lieu is required should you decide to leave the nursery for any reason. You will be required to do the same should you decide to reduce the number of days/sessions your child attends.

Privacy Notice
Here at the nursery we take your privacy seriously and will only use your personal information to manage your account and provide tailored care for your child. We may have to share information about your child with Ofsted or other agencies and other professionals who have a right to see them. We are required to work in partnership with other childcare settings your child may attend and any other professionals or agencies which might be involved with your child. Whilst we will try and let you know in advance that we are going to share information directly with other professionals, there might be some instance (such as safeguarding concerns or an emergency) when this is not possible.

On completion of a signed enrolment form, you agree to accept and abide with the terms and conditions outlined in the prospectus. This forms the nursery/parent agreement.
Child Name

First NameLast Name
Signature*

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Parent/Carer Name

First NameLast Name
Date

DayMonthYear
Date

EMERGENCY CONTACT INFORMATION
Child Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityCounty

Postcode
Parent/Carer 1 Name

First NameLast Name
Parent/Carer 1 Phone Number
Please enter a valid phone number.
Parent/Carer 2 Name

First NameLast Name
Parent/Carer 2 Phone Number
Please enter a valid phone number.
In the event of an emergency we will contact Parent 1 and Parent 2 in the first instance. If we are unable to reach Parent 1 or Parent 2 we will then contact the secondary emergency contacts listed below in the order that they are listed.
1. Name

First NameLast Name
Phone Number
Please enter a valid phone number.
Relationship to Child
2. Name

First NameLast Name
Phone Number
Please enter a valid phone number.
Relationship to Child
3. Name

First NameLast Name
Phone Number
Please enter a valid phone number.
Relationship to Child

PARENTAL CONSENT FOR OUTINGS AND VISITS
PARENT NAME agree to allow child CHILD NAME to participate in daytime outings.
I/We understand this might include:

travel by bus

travel by car

travel by tram / train

walking

The destination may include:

the library

the park

the garden centre

the shops

the market

the school

the children’s centre

On occasions, we may organise an outing, which may include other forms of travel or destination. These will be organised in advance and separate permission will be requested at the time.
Child Name

First NameLast Name
Signature*

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Parent/Carer Name

First NameLast Name
Date

DayMonthYear
Date

PARENTAL CONSENT TO ATTEND HOSPITAL IN CASE OF AN ACCIDENT

(This form will go with your child to hospital)
Child Name

First NameLast Name
Date of Birth

DayMonthYear
Home Address

Street Address

Street Address Line 2

CityCounty

Postcode
Phone Number
Please enter a valid phone number.
give permission for a member of staff at Little Learners Day Nursery to take child to hospital to receive treatment following an accident/injury at the nursery. If they cannot contact calpol be administered to my child.
Signature*

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Date

DayMonthYear
Date
Parent/Carer Name

First NameLast Name
The following information is to assist the hospital staff to ensure child receives appropriate treatment / care.
GP NAME
GP Address
GP Phone Number
Please enter a valid phone number.
Pet/Nicknames
Comforts
Regular Medication
Allergies
Dietary Requirements

FACE PAINTING
Every now and then, we do face painting as a special treat for the children. However not all parents/carers like their child to have their face painted. Please complete the form below so we can respect your wishes.
give permission for my child to have their face painted at nursery.
Child Name

First NameLast Name
Signature*

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Parent/Carer Name

First NameLast Name
Date

DayMonthYear
Date

SUN CREAM
I give my permission for a member of Little Learners staff to apply sun cream to my child as appropriate.
Child Name

First NameLast Name
Signature*

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Parent/Carer Name

First NameLast Name
Date

DayMonthYear
Date

ACTIVITIES
Please tick the boxes of the activities you are happy for your child to take part in:

Hand paintingFeet paintingBody paintingPlay doughJelly playShaving foam playCornflour playSand play
Child Name

First NameLast Name
Signature*

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Parent/Carer Name

First NameLast Name
Date

DayMonthYear
Date

BABY WALKER PERMISSION
I wish for my child to use the baby walker at nursery for short periods of time totalling up to a maximum of 1 hour a day.
Child Name

First NameLast Name
Signature

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Parent/Carer Name

First NameLast Name
Date

DayMonthYear
Date
NAPPY/BARRIER CREAM CONSENT
I have supplied Little Learners Day Nursery with:

BepanthanChild's FarmMetaniumSudocreamOther
If other, please state:
I give consent for a member of Little Learners staff to apply the above as and when they feel it is appropriate when changing my child or at every nappy change.

It is my responsibility to ensure that I regularly check the date to ensure it is still current on the cream.

The member of staff will record when cream has been applied and will inform me at the end of each day.
Child Name

First NameLast Name
Signature

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Parent/Carer Name

First NameLast Name
Date

DayMonthYear
Date

BIOMETRIC FINGERPRINT SYSTEM
As part of our security at the nursery, all parents and guardians are set up on our fingerprint system which will allow them to access the building during their child’s sessions.

By signing the below you agree to the set up and storage of your biometic fingerprint on the system and understand that the record will remain active until your child leaves the setting. Once your child has left the setting, your records will be deleted and access to the building will no longer be possible by this method.
Child Name

First NameLast Name
Signature*

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Parent/Carer Name

First NameLast Name
Date

DayMonthYear
Date

CCTV
The nurseries have external cameras for the purposes of ensuring the property and premises are secure at all times.

There are no cameras in toilets, for the privacy of the children, staff and visitors.

We as parents/carers are aware that CCTV is in operation within the inside and outside of the nursery.

If you require further information regarding the CCTV, please contact the nursery manager.
Child Name

First NameLast Name
Signature*

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Parent/Carer Name

First NameLast Name
Date

DayMonthYear
Date

GDPR PRIVACY NOTICE
At Little Learners Day Nursery we take privacy very seriously and we are currently updating all our records to ensure that we are fully meeting the new data protection standards (General Data Protection Regulation (GDPR)).

We are registered with the Information Commissioner's Office (ICO).

The categories of children's information that we collect, hold and share include:
- personal information (such as name, address, date of birth)
- characteristics (such as ethnicity, language, nationality, country of birth, early years pupil premium eligibility)
- attendance information (such as sessions attended, number of absences and absence reasons)
- observations and assessment information and tracking of progress
- medical information
- information on special educational needs and disabilities (including if accessing Disability Living Allowance and entitled the Disability Access Fund)
- referrals to other relevant services
- safeguarding information
We also collect, hold and share some information on the children's parents/guardians:
- personal information (names, address, contact numbers and emails)
- National Insurance number
Why we collect and use this information
We use the children's and parents' data to:
- support their learning and development, to enable staff to plan suitable activities to extend their knowledge and skills
- ensure that all children are safe within our childcare provision
- monitor and report on their progress
- provide appropriate behavioural and emotional support as required
- assess the quality of our services as a childcare provider
- comply with the law regarding data sharing (GDPR)
- meet the requirements of the early years foundation stage (EYFS)
- make claims for funding
The lawful basis on which we use this information
We collect and use children's information under the following lawful bases:
- Contract: the processing is necessary for a contract we have with you the parents/guardian of the child to provide childcare and the contract that we have with the local authority to provide funded childcare to eligible families.
- Legal obligation: the processing is necessary for us to comply with the law (submitting data for the early years census).
Collecting children’s information
While the majority of children's information you provide to us is mandatory, some of it is provided to us on a voluntary basis. In order to comply with the GDPR, we will inform you whether you are required to provide certain children's information to us or if you have a choice in this.

Storing children's data
We are required to hold children's data for a reasonable period of time after children have left the provision (eg until after the next Ofsted inspection) as a requirement under the EYFS. The Limitation Act 1980 recommends that we retain data until the child reaches the age of 21 - or until the child reaches the age of 24 for child protection records.

Your data will be held securely and will only be accessible by staff who are authorised to do so.

Who we share children's information with
We routinely share children's information with:
- schools that the child attends after leaving our provision
- other local childcare providers where the child is engaging currently (wrap around or blended childcare)
- our local authority (for funding claims and the early years census)
- the DfE (annual early years census)
- special education needs co-ordinators
- NHS services (health visitors and speech and language therapists)
Why we share children’s information
We do not share information about our children with anyone without your consent unless the law and our policies allow us to do so.

We share children’s data with the DfE on a statutory basis. We are required to submit data to our local authority [name the local authority] for them to submit as part of the annual early years census in January and to access childcare funding.

Data collection requirements
To be granted access to children's information, organisations must comply with strict terms and conditions covering the confidentiality and handling of the data, security arrangements and retention and use of the data.

Requesting access to your personal data
Under data protection legislation, parents and children have the right to request access to information about them that we hold. To make a request for your personal information, or be given access to your child's early years record, contact Jo Bennett.

You also the right to:
- object to processing of personal data that is likely to cause, or is causing, damage or distress
- prevent processing for the purpose of direct marketing
- object to decisions being taken by automated means
- in certain circumstances, have inaccurate personal data rectified, blocked, erased or destroyed
- claim compensation for damages caused by a breach of the Data Protection Regulations.
If you have a concern about the way we are collecting or using your personal data, we request that you raise your concern with us in the first instance. Alternatively, you can contact the ICO.

Contact
If you would like to discuss anything in this privacy notice, please contact: Name of childcare provision:

Little Learners Day Nursery

Name of Data Protection officer: Jo Bennett

Email: info@little-learners.net

Telephone number: 0208 649 7745
Child Name

First NameLast Name
Signature*

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Parent/Carer Name

First NameLast Name
Date

DayMonthYear
Date

EARLY YEARS FUNDING ENROLMENT FORM

REGISTRATION

PARENT/CARER INFORMATION

COLLECTION

HEALTH INFORMATION

SESSIONS

PRIVACY NOTICE

FUNDING

EMERGENCY CONTACT INFORMATION

PARENTAL CONSENT FOR OUTINGS AND VISITS

PARENTAL CONSENT TO ATTEND HOSPITAL IN CASE OF AN ACCIDENT

FACE PAINTING

SUN CREAM

ACTIVITIES

PHOTOGRAPH / VIDEO PERMISSION FORM

BABY WALKER PERMISSION

NAPPY/BARRIER CREAM CONSENT

BIOMETRIC FINGERPRINT SYSTEM

CCTV

GDPR PRIVACY NOTICE

HOW DID YOU HEAR ABOUT US?

REFERRALS