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"*" indicates required fields

1Childs Details
2Parent/Guardian 1
3Parent/Guardian 2
4Parent/Guardian Extra
5Medical Details
6Session Plan
7Permissions/General Questions
8Final Details
Address*
DD slash MM slash YYYY
(Please provide due date for unborn child)
Sibling*

Child’s Background

Parent/Guardian 1 address*
Parent/Guardian 1 main bill payer?*
Parent/Guardian 1 parental responsibility*
Parent/Guardian 1 funding contact*
Parent/Guardian 2 address
Parent/Guardian 2 main bill payer?
Parent/Guardian 2 parental responsibility
Parent/Guardian 2 funding contact
Are there any contact restrictions*
Are you or your partner in the armed forces?*
Does your family have a social worker?*

Other emergency contacts

Collections arrangements

Who is authorised to collect your child other than the parents? Your child will only be allowed to leave nursery with people listed here. Any changes to this information must be communicated to the nursery management team in writing.

Collection People*
Name
Relationship to child
 

As an extra precaution you may wish to use a password. Anyone collecting your child should be made aware of this. You should change this regularly.

Cannot be collected by anyone under 17

Doctors address*

Does your child have any special care requirements?

Medical Dietary Requirements*
Long term medication*
Disabilities*
Special dietary requirements*
Special and Educational or Additional support needs*
DD slash MM slash YYYY
DD slash MM slash YYYY
Schedule*

Preferred sessions

Full day sessions
Morning sessions (if offered)
Afternoon sessions (if offered)
Question:
Action:
Note for the child:
I give consent for photographs of my child to be displayed around the nursery*
I give consent for my child to feature in our nursery newsletter*
I give consent for my child to be photographed and featured on our public social media accounts*
I give consent for my child to be photographed/filmed and featured on our private social media accounts*
I give consent for my child to be photographed and featured in local newspapers, local publications*
I give consent for my child to be featured on our promotional materials including but not limited to banners, flyers, posters and on our website*
When my child is making the transition to school, I give my consent for the nursery team to contact my child’s school and share information about them and their development*
If my child attends another setting, I give consent for the nursery staff to contact and share information about my child and their development*
I give consent for the nursery team to contact and share relevant information with other healthcare and education professionals*
I give consent for the nursery team to administer emergency first aid and medication to my child when required (calpol/antihistamine) – England only/NA for Scotland*
I give consent for the nursery team to seek and administer any emergency medical treatment if required*
I give consent for the nursery team to apply nappy cream to my child when required*
I give consent for plasters to be applied when required. I can confirm my child is not allergic to plasters*
I give consent for the nursery team to apply high factor suncream when required*
I give consent for my child to participate in local walks in and around the nursery vicinity*
Clear Signature
Clear Signature
*

The nursery fees are stated in the Nursery Fee Fact Sheet, please request this from the Nursery Management team.

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England Office:
3 Central Park
Ohio Avenue
Media City UK
M50 2GT
0800 111 4954
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