Registration Form

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Child's Details

Sessions Required

MONDAY sessions *
TUESDAY sessions *
WEDNESDAY sessions *
THURSDAY sessions *
FRIDAY sessions *

(Please note that for 13 weeks of the year, sessions are charged at full price)

(Please note that for 13 weeks of the year, sessions are charged at full price. There is an additional charge for meals)

Free Education Funding Only

MONDAY free funding
TUESDAY free funding
WEDNESDAY free funding
THURSDAY free funding
FRIDAY free funding

Contact Details

Please indicate which TWO contacts are responsible for collecting your child from nursery. Should you wish for additional contacts to collect your child, you MUST inform management in writing before collection and they MUST know your secret password. They will be asked this at the office at the point of collection. For safeguarding reasons, we cannot allow children to be collected if these terms have not been met. You agree to this by signing this form during the registration process.

Contact 1
Responsible for Collecting Children from Nursery *

Contact 2
Responsible for Collecting Children from Nursery *

Contact 3
Responsible for Collecting Children from Nursery *

Bill Payer Details
Preferred Method of Payment (Please check)

Health/Doctor

Immunisations

Has your child had any of the following immunisations?

DTaP/IPV/Hib and PCV and Rota (8 Wks)

(diptheria, tetanus, acellular, pertussis (whooping cough), inactivated polio vaccine, Haemphilus influenza b (hib) vaccine and pneumococcal conjugate vaccine and rotavirus vaccine)

DTaP/IPV/Hib and PCV and Rota (8 Wks) *
DTaP/IPV/Hib and menC and Rota (12 Wks)

(diptheria, tetanus, acellular, pertussis (whooping cough), inactivated polio vaccine, Haemphilus influenza b (hib) vaccine and meningococcal C vaccine and rotavirus vaccine)

DTaP/IPV/Hib and menC and Rota (12 Wks) *
DTaP/IPV/Hib and PCV (16 Wks)

(diptheria, tetanus, acellular, pertussis (whooping cough), inactivated polio vaccine, Haemphilus influenza b (hib) vaccine and pneumococcal conjugate vaccine)

DTaP/IPV/Hib and PCV (16 Wks) *
Hib/Men C and MMR and PCV (12-13 Mths)

(Haemophilus influenza b (Hib)and meningococcal C vaccine and measles, mumps, rubella vaccine and pneumococcal conjugate vaccine)

Hib/Men C and MMR and PCV (12-13 Mths) *
DTaP/IPV or dTaP/IPV (3 Yrs 4 Mths)

(diphtheria or low dose diphtheria, tetanus, acellular pertussis, inactivated polio vaccine) PRE-SCHOOL BOOSTER

DTaP/IPV or dTaP/IPV (3 Yrs 4 Mths) *
MMR

(Measles, mumps, rubella vaccine)

MMR *
Influenza (2-3 Yrs)
Influenza (2-3 Yrs) *

Permissions

Seeking permissions helps us maintain trust and provide a safe, nurturing environment for all children. Please click 'yes' or 'no' if we have permission to:

Apply nappy cream? *
Apply sun cream? *
Apply face paints? *
Apply a plaster? *
Give first aid when necessary? *
Administer teething medication? *
Make observations? *
Administer Calpol in an emergency? *
Administer prescribed medication from the doctor? *
Take your child on outings in the local area? *
Photograph your child to be displayed within the nursery setting? *
Let your child appear on the online i-connect learning journey and possibly appear on other children's from time to time? *
Take photos of your child to be displayed externally for promotional materials such as social media groups, nursery website, leaflets, flyers or banners? *

Medicines

Please list any medicines that will need administrating in nursery on a permanent basis. Our management team, along with your child's key person, will need to speak with you further about these.

Additional Information

Terms and Conditions

Please download and read the Terms and Conditions