Registration Form

1
Which Little Lane Nursery branch do you wish to register with?* This field is required.
Stamford
Easton on the Hill
2
Have you already had a tour of the nursery and had verbal confirmation of your nursery space?* This field is required.Please note, that unless you have spoken to a member of The Little Lane Nursery team and had your nursery place confirmed, we will be unable to accept your application.
YESNO
3
Your Child's Name* This field is required.
First Name
Middle Name
Last Name
4
Known Child's NameIf different from above
5
Your Child's Date of Birth* This field is required.If your child is not yet born, please enter their due date
Date
Day
Month
Year
6
Gender
Male
Female
To be confirmed (pregnant)
7
Nationality* This field is required.
8
Religion
9
Languages
10
Does your child have any distinguishable birthmarks?* This field is required.
YESNO
11
If your child has a distinguishable birthmark(s), please provide details:
Huge
Large
Normal
Small
Ok
Ok
12
Was your child born before 37 weeks or had any complications at birth?* This field is required.
YESNO
13
If born before 37 weeks or had complications at birth, please provide further information:
Huge
Large
Normal
Small
Ok
Ok
14
Is there anything you wish to tell us about your birth experience or your early days of becoming a parent? To share this informatiom with us allows us to support you approriately. * This field is required.
Huge
Large
Normal
Small
Ok
Ok
15
Is there or has there been any involvement with Social Services and/or Court Orders in place?* This field is required.
YESNO
16
Security Password* This field is required.Please provide us with a security password that can be used by an adult, other than a parent/guardian, when collecting your child from nursery or in an emergency.
17
Doctor's Name(If known)
18
Doctor's Surgery* This field is required.
19
Doctor's Address* This field is required.
Street Address
Street Address Line 2
Town
County
Postcode
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
20
Doctor's Phone Number* This field is required.
Area Code
Phone Number
21
Take Photo* This field is required.In order to assist with safeguarding, please take a photo so that we have a record. Please note this is just for our internal records.
22
Primary Parent/Guardian - Name* This field is required.
Title
First Name
Last Name
23
Primary Parent/Guardian - Date of Birth* This field is required.This information is used when children start to receive early years funding.
Date
Day
Month
Year
24
Relationship to Child* This field is required.
25
Nationality* This field is required.
26
Languages
27
Religion
28
Address* This field is required.
Street Address
Street Address Line 2
Town
County
Postcode
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
29
Home Phone Number
Area Code
Phone Number
30
Mobile Phone Number* This field is required.
Area Code
Phone Number
31
Work Phone Number
Area Code
Phone Number
32
Email* This field is required.
example@example.com
33
Name of Employer
34
Employer Address
Street Address
Street Address Line 2
Town
County
Postcode
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
35
Do you wish to add the details of a secondary parent/guardian?* This field is required.
YESNO
36
Take PhotoIn order to assist with safeguarding, please take a photo so that we have a record. Please note, this is just for our internal records.
37
Secondary Parent/Guardian - Name* This field is required.
Title
First Name
Last Name
38
Secondary Parent/Guardian - Date of Birth* This field is required.This information is used when children start to receive early years funding.
Date
Day
Month
Year
39
Relationship to Child* This field is required.
40
Nationality* This field is required.
41
Do you have Parental Responsibility?* This field is required.Definition of Parental Responsibility: www.gov.uk/parental-rights-responsibilities/what-is-parental-responsibility A mother automatically has parental responsibility for her child from birth. A father usually has parental responsibility if he’s either: - married to the child’s mother - listed on the birth certificate (after a certain date, depending on which part of the UK the child was born in) You can apply for parental responsibility if you don’t automatically have it.
YESNO
42
Languages
43
Religion
44
AddressIf different from Primary Parent/Guardian
Street Address
Street Address Line 2
Town
County
Postcode
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
45
Home NumberIf different from Primary Parent/Guardian
Area Code
Phone Number
46
Mobile Number* This field is required.
Area Code
Phone Number
47
Work Number
Area Code
Phone Number
48
Email* This field is required.
example@example.com
49
Name of Employer
50
Employer Address
Street Address
Street Address Line 2
Town
County
Postcode
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
51
Is Secondary Parent/Guardian an emergency contact?* This field is required.
YESNO
52
Is Secondary Parent/Guardian authorised to collect from nursery?* This field is required.
YESNO
53
Name* This field is required.
First Name
Last Name
54
Address* This field is required.
Street Address
Street Address Line 2
Town
County
Postcode
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
55
Home Phone Number
Area Code
Phone Number
56
Mobile Phone Number* This field is required.
Area Code
Phone Number
57
Work Phone Number
Area Code
Phone Number
58
Relationship to Child?* This field is required.
59
Is emergency contact authorised to collect from nursery?* This field is required.
YESNO
60
Name* This field is required.
First Name
Last Name
61
Address* This field is required.
Street Address
Street Address Line 2
Town
County
Postcode
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
62
Home Phone Number
Area Code
Phone Number
63
Mobile Phone Number* This field is required.
Area Code
Phone Number
64
Work Phone Number
Area Code
Phone Number
65
Relationship to Child?* This field is required.
66
Is emergency contact authorised to collect from nursery?* This field is required.
YESNO
67
Do you wish to add a third emergency contact?
YESNO
68
Name
First Name
Last Name
69
Address
Street Address
Street Address Line 2
Town
County
Postcode
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
70
Home Phone Number
Area Code
Phone Number
71
Mobile Phone Number
Area Code
Phone Number
72
Work Phone Number
Area Code
Phone Number
73
Relationship to Child?
74
Is emergency contact authorised to collect from nursery?
YESNO
75
Does your child have any medical conditions?* This field is required.
YESNO
76
Please provide more details of your Child's medical condition(s):* This field is required.
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77
Are your Child's immunisations up to date?* This field is required.
YESNO
78
Does your Child suffer with any allergies?* This field is required.
YESNO
79
Please provide more details of your Child's allergies:* This field is required.
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Ok
80
Does your Child take any medication for a medical condition or allergy?* This field is required.
YESNO
81
Please provide details of medication taken:* This field is required.
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Ok
82
Does your Child have any dietary requirements?* This field is required.
YESNO
83
Please provide details of your Child's dietary requirements:* This field is required.
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Ok
84
Please confirm the days and sessions you would like your child to attend nursery:* This field is required.Please be aware at this stage the days and sessions you require and not guaranteed and will be subject to availability. A minimum of two full days or 4 AM or PM sessions required per week.
AM
PM
All Day
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Will you require an early start or late finish?:An early start is 7:30am and a late collection is 18:00pm, each of charged additionally to your standard nursery fees. Please be aware at this stage the days and sessions you require and not guaranteed and will be subject to availability.
Early
Late
Monday
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Tuesday
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Wednesday
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Monday
Tuesday
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Friday
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Row 0, Column 1
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Please confirm the date you wish your Child to start nursery:* This field is required.If you do not have a confirmed date, please indicate your anticipated start date. Please be aware at this stage the days and sessions you require and not guaranteed and will be subject to availability.
Date
Day
Month
Year
87
Availability of your required nursery sessions* This field is required.I/we understand that the days and sessions required are not guaranteed until availability has been confirmed in writing by the nursery.
YESNO
88
I/We give permission for details of my child and our family to be held on the software used by The Little Lane Nursery* This field is required.I/we give permission for details of my child and our family to be held on the following cloud software systems and for observations to be made and developmental records kept: - 'Famly' - Nursery management software - 'Dropbox' - Document repository software - and where required, paper copies within a locked filing cabinet in the office. All information held by the nursery under the Data Protection Act 2018 I/we understand that we will receive emails or correspondence via the ‘Famly’ nursery software or standard nursery email address regarding my child’s daily activities, development progress, nursery newsletter and any other information that is appropriate.
YESNO
89
I/We give permission for The Little Lane Nursery to share information with outside agencies (i.e. health visitors, local schools, speech therapists, area SENCOs, other settings etc), if required.* This field is required.
YESNO
90
I/We give my child permission to touch/handle animals under supervision.* This field is required.I understand hand washing will be a high priority. If we have any animals visiting the nursery, you will be informed first.
YESNO
91
I/We give permission for photographs and/or videos being taken of my child and used on our nursery software, 'Famly', and on internal displays.* This field is required.The nursery software, 'Famly' is a private system that can only be accessed by families attending The Little Lane Nursery.
YESNO
92
I/We give permission for photographs and/or videos being taken of my child and used on the nursery website, on social media (Facebook and Instagram) and on occasion local press/magazines.* This field is required.The social media platforms are not closed and are open pages.
YESNO
93
I/We give permission for my child to participate in local outings.* This field is required.Local outings may include a walk to the local park, feeding the ducks, visiting the local library etc. This statement only applies to outings within walking distance of the nursery in the local area. Outings requiring hired, public transport or the nursery minibus will be subject to separate permission form. The nursery will use a variety of transport methods, including quad pushchairs, walking wagon, 'Walkodile' (harness used to keep walking children safe) and holding a staff members hand.
YESNO
94
I/We give permission for my child to participate in extracurricular activities (for example Jo Jingles, Baby Yoga) for a small additional charge that will be added to my invoice.* This field is required.
YESNO
95
I/We agree not to bring my child or any household member to nursery if they have any symptoms on the current NHS or Public Health England list of Covid-19 symptoms. * This field is required.I/We understand that if my child develops any symptoms on the list of Covid-19 symptoms whilst at nursery, that they will be isolated and must be collected as soon as possible. I/We understand that my child will be unable to return to nursery until they have had a Covid-19 test and received a negative result (evidence will be required) or unless they have isolated for 14 days. I/We understand that we must advise nursery as soon as possible if my child or anyone in our household tests positive for Covid-19. I/We confirm that we will follow the guidelines released by the Government regarding Covid-19, including but not limited to social distancing.
YESNO
96
I/We give permission for nursery staff to check my Child's head for signs of headlice.* This field is required.If headlice are found we will require your Child to be collected from nursery and treated.
YESNO
97
I/We give permission, if required, for staff to apply hypoallergenic plasters to my Child.* This field is required.
YESNO
98
I/We give permission, if required, for nursery staff to apply nappy cream to my Child.* This field is required.You must provide nappy cream, which must be clearly labelled with your Child's name and given to a member of staff. If your Child requires nappy cream and none has been provided, we will contact you for permission to purchase some (brand to be agreed) and the cost added to your invoice.
YESNO
99
I/We give permission for sunscreen to be applied to my Child.* This field is required.You must provide a bottle of high level SPF sunscreen, which must be clearly labelled with your Child's name and be within its use by date. If your Child requires sunscreen and none has been provided, we will contact you for permission to purchase some (brand to be agreed) and the cost added to your invoice.
YESNO
100
I/We give permission for my Child to participate in brushing their teeth.* This field is required.Each Child will be provided with their own toothbrush, clearly labelled with their name and kept in a secure container, and toothbrushing won't take place until at least 1 hour after eating. Toothbrushes are replaced every 12 weeks.
YESNO
101
I/We give permission, in the event of an emergency, for my Child to receive emergency first aid by a trained first aider within the nursery.* This field is required.
YESNO
102
I/We give permission, in the event of an emergency, for the nursery to seek emergency medical treatment or advice in my absence.* This field is required.
YESNO
103
I/We give permission, in the event of an emergency and an ambulance not required, for my Child to be transported in a registered taxi, the nursery minibus (in age appropriate seat) or in a Director's car (insured for business use and with an age appropriate seat), if further treatment required.* This field is required.
YESNO
104
I/We give permission for my Child to be given liquid paracetamol (e.g. Calpol), in line with the manufacturer’s guidelines (i.e. age), in the event of them needing it to control a high temperature or for teething. * This field is required.I/We understand that I will be contacted before my child receives liquid paracetamol. I/We understand that if my Child is deemed to be unwell I will have to collect them from nursery. If I/we can not be contacted I/we agree that liquid paracetamol can be given in the event of a high temperature by a manager/or person in charge. I/we understand that I must provide a bottle of liquid paracetamol (e.g. Calpol), in the original box and bottle, clearly labelled with my child’s name and give it to a member of staff and not left in my Child’s belongings bag. I understand that the nursery are unable to administer liquid paracetamol (e.g. Calpol) to my Child within 4 hours of arriving at nursery and for more than 3 consecutive days unless prescribed by a doctor. I/We understand if liquid paracetamol has not been provided and is required, that I will be contacted for permission to purchase liquid paracetamol (brand to be agreed) on my behalf and the cost added to my next invoice. I/We understand that the nursery policy does not allow Ibruprofen (e.g. Calprofen), Aspirin or any other over the counter medication (including cough syrup) to be administered unless prescribed by a doctor.
YESNO
105
I/We give permission for my Child being given antihistamine (e.g. Piriton), in line with the manufacturer’s guidelines (i.e. age), in the event of them needing it for an allergic reaction (e.g. reaction to a wasp sting). * This field is required.I understand that I/we will be contacted before my child receives antihistamine. I/we understand that if my child is deemed to be unwell I will have to collect them from nursery. If I/we can not be contacted I agree that antihistamine (e.g. Piriton) can be given in the event of an allergic reaction.
YESNO
106
I/We give permission for my Child to be given teething aids (e.g. Nelsons Teething Granules or Bonjela), in line with the manufacturer’s guidelines, in the event of them needing it to help with teething pain.* This field is required.I/We understand that I/we must provide the teething aids in the original box and packaging.
YESNO
107
In the event of my Child being prescribed medication from a doctor/dentist/nurse/pharmacist, I/we give permission for my child to be given prescribed medication whilst at nursery. * This field is required.I/We understand that I/we will have to complete a medication form for each prescribed medicine and understand this can only be done by a Parent/Guardian with parental responsibility. Medicine will only be given to a child named on the bottle for dosage stated. I understand that I/we must notify the nursery IMMEDIATELY if anything changes (e.g. dosage has been given at home or change of dosage). I/We understand that in the event of my child being prescribed medication from a doctor that they must have had 24 hours on the medication and well in themselves before returning to nursery.
YESNO
108
Where did you hear about us?* This field is required.
Facebook
Local Press
Instagram
Search Engine
Recommendation
Minibus
Seen us on an outing
Other
109
Terms and Conditions* This field is required.Please review the attached document and tick to confirm you have read and understood.
110
Nursery Fees Charges* This field is required.Nursery fees are annualised and split into equal monthly payments, so standard nursery fees are the same amount each month. Any additional sessions, early/late sessions or extra curricular activities are charged at the time of accessing these and will be added to the next months invoice. Nursery fees are charged all year round, including Bank Holidays, Christmas closure and for any absences from nursery (for example holidays, illness).
111
GDPR* This field is required.Please review the attached document and tick to confirm you have read and understood.
112
The Little Lane Nursery Policies & Procedures* This field is required.Please review the attached document and tick to confirm you have read and understood.
113
Primary Parent/Guardian* This field is required.By signing this registration form, I am confirming that I have read and understood the following nursery: - Terms & Conditions - Permissions - Policies & Procedures - GDPR Policy I understand it is nursery policy that parents and staff are not in contact through social networking sites, such as Facebook, Instagram or Twitter, except on The Little Lane Nursery and/or The Little Lane Nursery (Easton on the Hill) platforms. I understand that this form is a legally binding document. Please note where both parents/guardians register for a nursery place, both shall be jointly responsible for nursery fees and monies owed to the nursery throughout the life of this contract. Any changes to the information provided need to be notified by someone with parental responsibility. In order to confirm your child’s registration, we will require sight of your child’s original birth certificate. The nursery registration fee of £100 Registration Fee (non-refundable) and £150 Deposit (refundable, see Terms & Conditions) will be made by bank transfer on completion of this form. The nursery place can not be confirmed until this payment has been received.
Clear
114
Secondary Parent/GuardianBy signing this registration form, I am confirming that I have read and understood the following nursery: - Terms & Conditions - Permissions - Policies & Procedures - GDPR Policy I understand it is nursery policy that parents and staff are not in contact through social networking sites, such as Facebook, Instagram or Twitter, except on The Little Lane Nursery and/or The Little Lane Nursery (Easton on the Hill) platforms. I understand that this form is a legally binding document. Please note where both parents/guardians register for a nursery place, both shall be jointly responsible for nursery fees and monies owed to the nursery throughout the life of this contract. Any changes to the information provided need to be notified by someone with parental responsibility. In order to confirm your child’s registration, we will require sight of your child’s original birth certificate. The nursery registration fee of £100 Registration Fee (non-refundable) and £150 Deposit (refundable, see Terms & Conditions) will be made by bank transfer on completion of this form. The nursery place can not be confirmed until this payment has been received. I understand that the nursery fees may change between the time of registering for a place and my child(ren) starting and these can be viewed online at www.littlelanenursery.com.
Clear
115
Date
Date
Day
Month
Year
116
Please make a note of our bank details for each of our nursery settings, for total payment of £250 for the Registration Fee (£100) and Deposit (£150).
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