LITTLE PIPPINS PRE-SCHOOL & BREAKFAST CLUB
CHILD INFORMATION & ‘PERMISSIONS’ FORM
Child’s full name: ………………………………………………………………………………….…………….
Name used, if different from above: ………………………………… Date of birth: ………………………..
Home address:……………………………………………………………………………….…………….….….
Tel: …………………………………………….. email: …………………………………………………………
Name of parent/carer: ………………………………………Relationship to child: …………………………
Address, if different from child’s address above: ……………………….………………………………..….
Tel:………………………Mobile:……………………………email:……………………………………….…….
Place of work: ………………..………… Tel: ……………………. email: …………………………….…….
Name of parent/carer: ………………………………..…… Relationship to child: ……………….……...
Address, if different from child’s address above: ……………………………………………………....……..
Tel:………………………Mobile:……………………………email:...... ……………………………………
Place of work: ………………………..… Tel: …………………… email: ……………………………………
Alternative emergency contact: …………………………………Mobile/Tel…………………….…………
*Who has parental responsibility for the child? ………………………………………………………..……..
*Names of any people who have been given the legal right to have contact with this child, by a court (if applicable):
......
Child’s doctor: ………………………………..………… Tel: ………….………………………………….....
Doctor’s address: ………………………………………...………………………………………….…………
Main language used: …..……………….. Nationality: ……………..……. Religion: ………………..……..
Cultural or religious observances that should be taken into account when caring for the child (e.g. diet, dress, religious holidays)
………………………………………………………………………………………………………………………
Health matters the setting should be aware of:
………………………………………………………………………………………………………………………
Dietary requirements/preferences: ………………………………………………………………………..……
………………………………………………………………………………………………………………………
Any known allergies: …………………………………………………………………………………..…………
………………………………………………………………………………………………………………………
*It is a legal requirement that we have these details for EYFS-age children. Information on parental responsibility is available at www.direct.gov.uk
Please return the completed form to Little Pippins Pre School, Freeman Orchard, Gaveston Road, Harwell, Didcot, OX11 0HP.
Child’s full name: …………………………………………………………………………………….
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Child’s full name: ……………………………………………………………………………………………….
Any additional information: ……………………………………………………………………………………….
……………………………………………………………………………………………………………………….
Name of person who completed this form: ………………………………………………………..……….
Signature: ………………………………………………………………………… Date: …………………..…
Relationship to child named above: ……………………………………………………………..………….
PREFERRED SESSIONS
We endeavour to provide you with the sessions you request but this will depend on availability. We will confirm sessions with you closer to your start date. Please indicate below which are the preferred sessions you would initially like your child to attend:
Preferred start date: ……………………………………………….
Monday / Tuesday / Wednesday / Thursday / FridayBreakfast Club
Morning Session
Lunch
Afternoon Session
TERMS & CONDITIONS
Once your child is on the register, we expect your child to attend on the day/s allocated to them. The registration form is a contract, and you are liable to pay all the fees until you give notice of leaving. Parents are required to become a member of Little Pippins when their child starts attending.
It is our policy that all fees are paid in advance of every session. Fees cannot be returned for sessions not attended. If your child is sick, sessions missed must be paid for. This is because we still have to cover all the pre-school’s running costs, including staff pay.
If fees remain outstanding after issue of a written reminder, Little Pippins will only be able to provide six 2½ hour sessions a week funded through the Nursery Education Fund. Any other sessions will be withdrawn until the outstanding debt is cleared. Once payment is received, additional sessions may be requested following negotiation with the Supervisor and Management Committee.
Each parent is expected to provide help for at least one session per term. You will be advised each half term of your Parent Helper rota dates.
I wish to register my child at Little Pippins and agree to abide by these Terms and Conditions.
Signed: ………………………………………. Name: …………………………………………
Date: ……………………………...
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