Registration Form

Name of Child
Date of Birth
Parent(s) / Guardian(s)
Home Address(1)
Telephone
Work Address(1)
Telephone
Home Address(2)
Telephone
Work Address(2)
Telephone

 

Child's Doctor
Address
Telephone
Name(1)
Relation
Telephone
Name(2)
Relation
Telephone

 

Child's Religion
Special Diet
Allergies
Any Health Concerns

 

Immunisation & Vaccinations to Date (Please Give Dates)

 

Has your child had any infectious diseases. e.g. chicken pox? Please give details:

 

Is there anything else you would like us to know about your child, e.g. any like or dislikes, fears or problems, routines, favourite toys etc?

 

I hereby permit Small Wonders Nursery to authorise any emergency medical treatment to my child should the need arise (every possible effort will be made to contact a parent before this authorisation is brought into effect).

I hereby permit Small Wonders Nursery to take my child off the premises on visits to attractions in the locality.

I hereby authorise Small Wonders Nursery to administer medicines brought in by myself to my child. No other medicines will be administered.

I understand that I give one month's written notice or payment in lieu of notice if I wish to increase or decrease my child's nursery sessions or if I wish to cancel my child's nursery place.

I permit the use of photographs of my child and video recordings of my child in the nursery and for students undertaking placement at the nursery in relation to college assignments.

I understand that all sessions are payable at all times whether my child attends nursery or not, as fees have been calculated taking into account two weeks summer holiday, one week Christmas holidays and all bank holidays.

I have read and understood all of Small Wonders Nursery's rules, regulations, Terms and Conditions and agree to abide to them.
Name
Date

 

Start Date
Attending (Please mention which days, mon - fri specifying AM, PM or both)
Notes