APPLICATION FORM-
| Childs Name: |
Parent/Guardian Name: |
| Address: |
Childs date of birth: |
| City/Town: |
Telephone Number: |
| Postcode: |
Mobile/Emergency Telephone Number: |
| E-mail Address: (if applicable) |
Does your child have any disabillities: (If no continue to next question) |
| Does your child have any allergies: (If NO continue to next question.) |
Do we have your permission to photograph your child? yes no |
| Childs Religion: |
Do we have your permission to contact a Doctor in an emergency? yes no |
| Doctor's Name: |
Doctor's Surgery: |
| Pre-school sessions required (3 to 5 years): Monday 12.30pm-3.00pm Tuesday 9.15am-11.45am Wednesday 12.30pm-3.00pm Thursday 9.15am-11.45am Friday 12.30pm-3.00pm |
Playgroup sessions required (2 to 3 years): Monday 9.15am-11.45am Tuesday 12.30pm-3.00pm Wednesday 9.15am-11.45am Thursday 12.30pm-3.00pm Friday 9.15am-11.45am |
| Parents Signature: |
Staff Signature: |
Children may start at Playgroup from 2 Years old. If your child attains the age of 3 years by the 31st August, they should attend Pre-school sessions. A registration fee of £1 must be paid at the time of registration. By signing this form you agree that you will read the operating practices of the nursery as contained in the current edition of the handbook. |
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| Please click here to print a completed copy of this form for delivery to the nursery | |