Early Years Pre-School

HUMPTY DUMPTY PLAYGROUP

(Early Years Pre-school)

Kesgrave Community Centre, Twelve Ace Approach

Bell Lane, Kesgrave, IP5 1JF,

Tel: 07837 154081(during playgroup hours only)

Registration Form

Name of child………………………………………………..….…..…….. Date of birth…….………..…….

Address ………………………………………..……………………………….……….Post code………………..

Tel. no ………………………………..……………..………Mobile no ……………………….….…..…………..

Emergency contact and mobile no ……………………………….…….………………………………….……

Parent’s full names ………………………………………………………….……………Religion…………….

Who has parental responsibility? …………………………….…………………………………………….…..….

Any person who does NOT have legal access to child ……………………………………………………………..

Name and date of birth of other children in family ……………………………………..……….……………...

Child-minder’s name, address and tel. no.………………………………….…………………..………………

Name of any other playgroup/nursery child attends …………………………………………………………..

Doctors name, address and tel.no ……………………………………………………………………………….

…………………………………………………………………………………………………………………………..

Health Visitors name, address and tel. no. ………………………………………………………………..

…………………………………………………………………………………………………………………..

Does your child suffer from any illness, special educational needs or disability, which may affect him/her at playgroup?

………………..……………………………………………..…………………………………………………………………………

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PLEASE LIST ANY KNOWN ALLERGIES TO FOOD, DRINK, ANIMALS, OR ANY SPECIAL

DIETRY REQUIREMENTS; eg. Vegetarian or religion……………………………………………….………

………………………………………………………………………………………………………………………..

At snack time, children are offered milk or water, a selection of fruits/vegetables and breadsticks.

Children are requested to bring their own drinks (either water or diluted sugar free cordial) in named water bottles. Water is always available in session.

All children are eligible for 15 hours a week of free early education funding and lunch, in the term after they turn 3 years old. Is your 2 year old eligible for free funding? Please read letter from Suffolk Families Information Service attached.

Our fees are £3.50 per hour (£10.50 per session), £1.50 for lunch sitting.

Morning session’s 9:00am to 12:00noon Afternoon sessions 12:30pm to 3:30pm

Would you prefer morning or afternoon sessions?......

Lunch is available 12:00noon to 12:30

Would you be interested in your child attending lunch? Yes/No

HMGovernment Information Sharing:Guidance for Practitioners and Managers (DCSF, 2008),instructs the playgroup, that through our‘Information Sharing Policy’ (all policies can be accessed in the setting) parents/carers are asked to sign the registration form to say that they understand the circumstances in which information may be shared without their consent. This will only be when it is a matter of safeguarding a child or vulnerable adult.

On occasions we may take the children for walks in the local area, we need your permission to take children out of the setting. Please sign to give your permission below. Advance notification will be given.

Humpty Dumpty Playgroup is registered with the Information Commissioners Office (ICO). This is a requirement enforced by the Data Protection Act 1998. Please sign to give your consent for us to hold your child’s details on the premises. No information will be disclosed to third parties.

I confirm that all details are complete and correct. In the event of illness or accident I give permission for any medical treatment to be given by the nominated first-aider. In an emergency, if I cannot be contacted, I am willing for my child to receive any hospital treatment which becomes necessary. I understand that every effort will be made to contact me as soon as possible.

Signature of parent/carer ………………………………………………………………………..

Date ………………………………….………...

You will be contacted with more details before your child starts playgroup, but meanwhile if you wish to discuss any matter, please telephone 07837154081 during playgroup hours, or Sally Cutts (Manager) on 01473 625998.