Grove Hall Nursery Ltd REGISTRATION FORM

Registration process

• If you require a place for your child complete and submit registration form, to then secure your place we require £150 registration fee ( non refundable) paid in cash or bank transfer only.
• Adaptation will then take place a week before your child's official start date.
• Adaptation details will be sent to you via email.

Surname of Your Child:*	First Name:*	Sex:*
	(First enter generally used name )	F M

Date of Birth:*	Place of Birth*
Nationality:*	Mother tongue:*
Other languages:	Ethnic origin:
Emergency contact name*	Emergency contact tel.*
Emergency contact name (2)*	Emergency contact tel. (2)*

Type of Place: (please tick)
DAY NURSERY All year round: aged 5 months to 4 years
Short Hours:	8h00-16h00 8h30-16h30
Long Hours: 7h30 – 18h30
Full-Time	Part-Time : Minimum attendance is 3 days
Full-day	Monday /  Tuesday /  Wednesday /  Thursday /  Friday

Proposed date of Entry:
First choice:	Second choice:	Not sure:

Have you registered your child's name at any other school's and if so, which?

Father's Title, Full Name, Address and Occupation:

Home:*	Work:*
Mobile:*	E-mail:*

Mother's Title, Full Name, Address (if different from the above) and Occupation

Home:*	Work:*
Mobile:*	E-mail:*

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Please mention here the names of any other members of the family attending the School or registered for entry; or any other connection with the School.



Please say how you first heard of the School. Was it from:

Local Reputation	Present School	Friends
Advertisement (name of publication)	Other (Please give details)

Please state the name and address of the present school (with dates):	Name of Head / Principal:

Early registration is recommended. A non-returnable Registration/Administration Fee of £150 is payable before the School will consider applications for Registration. Registrations will be considered in the order they are received. Offers of places are subject to availability and the admission requirements of the School at the time offers are made. A copy of the current edition of the standard terms and conditions will be supplied upon the offer of a place by the school.

We request that the name of our above-named child be registered as a prospective pupil. A payment for the non-returnable Registration/Administration Fee of £150 is paid in cash or bank transfer. We understand that the standard terms and conditions of the School will undergo reasonable changes from time to time as circumstances require and will apply in all our dealings with the School. We understand also that the School (through the Principal, as the person responsible) may obtain, process and hold personal information about our child, including sensitive information such as medical details, and we consent to this for the purposes of assessment and, if a place is later offered, in order to safeguard and promote the welfare of the child.

First Signature:			Date:
Name in full:			Relationship to the Child:
Second Signature:			Date:
Name in full:			Relationship to the Child:he Child:

Child's Medical History
	(updated regularly) Date:
	Signature: Parents/Doctor: ...................................
Child's Name (capital letters):
Name of Child's Medical Practitioner:
	Address:
	Postcode:	Tel:

Record of Infectious Diseases
Record of Vaccinations and Immunisations (please tick or comment as appropriate)

Diphtheria	Yes No
Poliomyelitis	Yes No
Tetanus	Yes No
Measles	Yes No
Whooping Cough	Yes No
MMR	Yes No

Record of Illness

Asthma	Yes No		Infections	Yes No
Hay Fever	Yes No		Scarlet Fever	Yes No
Chicken Pox	Yes No		Eczema	Yes No
Measles	Yes No		Tuberculosis	Yes No
Convulsions	Yes No		German Measles	Yes No
Ear Trouble	Yes No		Whooping Cough	Yes No

Accidents and Operations (nature, date):

Others:

Special Dietary requirements (if any) :

Sleep patterns: Does your child have a comforter?(e.g., dummy, blanket, toy, etc.)

Anything else we need to know about your child? (e.g., habits, fears, special words)