Grove Hall Nursery Ltd
REGISTRATION FORM
Surname of Your Child:
*
First Name:
*
Middle Name:
Sex:
*
F
M
Date of Birth:
*
Place of Birth:
*
If TBC please update us after birth.
Nationality:
Mother tongue:
*
Other languages:
Ethnic origin:
Emergency contact name (excluding parents):
*
Emergency contact tel.: (excluding parents)
*
Emergency contact name (excluding parents) (2):
*
Emergency contact tel. (excluding parents) (2):
*
Type of Place:
(please tick)
DAY NURSERY All year round: aged 5 months to 4 years. 7:30 - 18:30
Full-Time
Part-Time : Minimum attendance is 3 days
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?
Title:
Mr.
Father's First Name:
*
Middle Name:
Last Name:
*
Occupation:
Address:
*
Town/Region:
*
Post code:
*
Country:
*
Home:
*
Work:
Mobile:
*
E-mail:
*
Title:
Ms.
Mrs.
Miss
Mother's First Name:
*
Middle Name:
Last Name:
*
Occupation:
Same address
Address:
*
Town/Region:
*
Post code:
*
Country:
*
Home:
*
Work:
Mobile:
*
E-mail:
*
If you have attending sibling, please tick.
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:
Child's Medical History
(updated regularly) Date:
Signature: Parents/Doctor: ...................................
Child's Name (capital letters):
Name of Child's Medical Practitioner:
Address line 1:
Address line 2:
Postcode:
Tel:
Record of Infectious Diseases
Record of Vaccinations and Immunisations
(please tick or comment as appropriate)
Date
Description
Diphtheria
Yes
No
Poliomyelitis
Yes
No
Tetanus
Yes
No
Measles
Yes
No
Whooping Cough
Yes
No
MMR
Yes
No
Record of Illness
Date
Description
Asthma
Yes
No
Hay Fever
Yes
No
Chicken Pox
Yes
No
Measles
Yes
No
Convulsions
Yes
No
Ear Trouble
Yes
No
Infections
Yes
No
Scarlet Fever
Yes
No
Eczema
Yes
No
Tuberculosis
Yes
No
German Measles
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.):
Allergies:
Anything else we need to know about your child? (e.g., habits, fears, special words):
DECLARATION
We (the parents/carers) agree to the following:
Deposit: We acknowledge that a
£200 non-refundable deposit
is required to formally reserve a place for our child. We understand that this payment must be made
by bank transfer only
.
Email validation: We understand that after the form is Submitted, we will receive an email with a validation link. We agree to validate our email address in order to finalise the registration process.
Adaptation period: We understand that an adaptation period will take place one week prior to our child's official start date. Specific details regarding this schedule will be sent to us via email.
Terms & Conditions: We accept the nursery’s standard terms and conditions. We understand these may undergo reasonable updates, and the nursery will inform us of any amendments or fee increases prior to our child’s start date.
Data processing: We consent to the Nursery holding and processing personal data about our child (including sensitive information such as medical details) for the purposes of assessment and safeguarding our child's welfare.
Withdrawal & data Protection: If we decide not to proceed with this application, we agree to notify the nursery immediately so our registration can be cancelled. If we decide to withdraw or if our application is unsuccessful, our registration form and personal data will be permanently deleted from Grove Hall system.
I've read and agree to
privacy policy
I've read and agree to
terms and conditions
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