Child Registration Form

FREE education & childcare for 2, 3 & 4 year olds

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Child Registration Form

Please complete prior to your parent meeting, your child registration form will be sent to our secure email for processing.

Admission Form

Forename:

Middle name:

Surname:

Child DOB:

Known as:

Home address:

Postcode:

Gender:

Ethnicity:

Religion:

Language spoken at home

Additional languages spoken within the family - please state

School child will attend at age 5 years:

Our family home is...

Title:

Forename:

Surname:

Address:

Postcode:

Home Tel:

Work Tel:

Mobile No:

Email:

Primary Contact:

Title:

Forename:

Surname:

Address:

Postcode:

Home Tel:

Work Tel:

Mobile No:

Email:

Relationship to child:

Parent DOB:

National Insurance Number:

Place of work:

Primary Contact has Parental Responsibility:

Primary Contact is authorised to collect:

Primary Contact is Emergency Contact:

Title:

Forename:

Surname:

Address:

Postcode:

Home Tel:

Work Tel:

Mobile No:

Email:

Relationship to child:

Parent DOB:

National Insurance Number:

Place of work:

Secondary Contact has Parental Responsibility:

Secondary Contact is authorised to collect:

Secondary Contact is Emergency Contact:

Enter Additional Emergency Contact:

Title:

Forename:

Surname:

Address:

Postcode:

Home Tel:

Work Tel:

Mobile No:

Email:

Relationship to child:

Place of work:

Has Parental Responsibility:

Is authorised to collect:

Is Emergency Contact:

Doctors Name:

Doctors Practice:

Doctors Address:

Doctors Postcode:

Doctors Tel:

Doctors Emergency Tel:

I give permission for my child to receive emergency medical attention:

Is your child upto date with their immunisations?

Do you have a named Health Visitor?

Are there any special health considerations

Does your child have a Medical Care Plan - If so please enter brief details

Does your child have any special dietary requirements

Does your child have an allergy?

Does your child have Special Educational Need or disability? - If so please enter brief details

Is your child known to the Child Development Centre 'CDC'?

Is your child under the care of the local authority?

Is your child on the Child Protection Register?

Is your child on a Child in Need plan

Is there a child arrangements order in place?

Do you have a named Social Worker

Are there any court orders in place:

Are there any adults that are prohibited contact with your child:

Does your child have any daily care requirements:

Has your child had a 2 year check?

Family Password... Please choose a password for authorised collections:

My child can sleep at... please state times:

My child is allowed to sleep for.... please state how long:

My child falls asleep quickly if... please give details:

My child likes to sleep in...

If my child falls asleep...

My child has a bottle at....

My child has a dummy/comforter...

My child is comforted by...

My child's interests and likes are

My child's dislikes are...

My child uses particular words for...

My child normally lives with...

My child's brothers and sisters are...

My child knows these children at nursery...

Do you give Charlie Caterpillars permission to contact you with any information regarding nursery?

Do you give permission for Charlie Caterpillars to use photographs to record your child's development?

Do you give permission for your child's photographs to be used for displays within the nursery?

Do you give permission for your child's photographs to be used for Charlies website?

Do you give permission for your child's photographs to be used on Charlies facebook page?

Can your child have face paints applied?

Do you give permission for your child to attend local outings during their nursery day?

Do you give permission for your child to be transported in a vehicle?

Do you give permission for your child to wear plasters?

Do you give permission for your child to wear suncream? - Nivea Sun Kids SPF 50+ only)

How often does your child need their nappy changed?

Does your child need barrier cream? - Supplied by parent

Does your child have any identifying marks ie. birth mark

We take the privacy of our families seriously, and in accordance with the General Data Protection Regulation (GDPR), we will process any personal data according to the seven principles, please see our GDPR Privacy Policy for further details.

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