Benson C of E Primary School
Oxford Road, Benson, Wallingford, Oxfordshire, OX10 6LX
Tel: 01491 202502 Fax: 01491 201546
E-mail:
Website: www.benson.oxon.sch.uk
Headteacher: Mrs Helen Crolla
Deputy Headteacher: Mrs Shelley Mottram
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Benson CE Primary School – Nursery Class
Registration Form
CHILD’S DETAILS
First Name(s) / SurnameKnown as / Date of Birth
_ _ / _ _ / _ _
Nationality / Main Language Used
Home Address
Post Code / Home Telephone No. (inc. STD code)
PARENTS/CARERS DETAILS (e.g. Mother and/or Father or alternative Primary Carer)
(Mother) First Name / SurnameHome Address / Home Phone No.
Work Phone No.
Post Code / Mobile Phone No.
Email Address.
(Father) First Name / Surname
Home Address (if different from above) / Home Phone No.
Work Phone No.
Post Code / Mobile Phone No.
Email Address.
PLEASE PROVIDE THE FOLLOWING INFORMATION
Who has legal contact with the child? / Who has parental responsibility for the child?ALTERNATIVE CONTACTS IN CASE OF EMERGENCY
Name / Home Phone No.Relationship to child / Work Phone No.
Mobile Phone No.
Name / Home Phone No.
Relationship to child / Work Phone No.
Mobile Phone No.
NAMES OF OTHER PERSONS WHO MAY COLLECT THE CHILD
Name / Relationship to childNAMES OF PERSONS WHO MAY NOT COLLECT THE CHILD
Name / Relationship to childREGISTERED DOCTOR
Dr’s NameAddress / Telephone No. (inc. STD code)
HEALTH VISITOR
Name / Telephone No. (inc. STD code)Are there any difficulties with the child’s SIGHT, HEARING or SPEECH? / Y / N If yes, please describe
OTHER INFORMATION
ReligionDetails of religious/cultural observances to be taken into account (e.g. diet, dress, etc.)
Please describe any special health requirements and detail any regular prescribed medicine
Allergies: Asthma
Hay Fever
Others / Y / N
Y / N
Y / N If yes, please specify
Special dietary needs / Y / N If yes, please specify
Any food handling allergies / Y / N If yes, please specify
I give my permission for staff to put a plaster on my child if necessary / Y / N
If no, please specify type of dressing that may be used, if any:
Is your child left or right-handed? / L / R
Previous Pre-school / Playgroup / Nursery
Any other Pre-school / Playgroup / Nursery child attends
Proposed Primary School
Term start date for proposed school
Please state if your child has any real fears or dislikes
Special talents/interests of child
Special interests/hobbies/skills you have and are willing to share with Pre-school
Refreshments
Our daily refreshments include either a drink of milk or water. The snack always includes a fruit option and an alternative such as toast, breadsticks or cream crackers.
Local Walks/Visits
Occasionally, the children may go out for local walks and visits in closely supervised groups.
I give my permission for my child to be taken out of Nursery on supervised local visits Yes / No
Use of ICT equipment
The School has an Acceptable Usage Policy for the use of all ICT, photographic and mobile technology. I give permission for my child to use this equipment under the terms of this policy.
Yes / No
Information Sharing
I give permission for Benson School to share my child’s records with other schools and settings that they attend(ed) or will attend
Yes / No
Cycle Helmets
As I am sure you are aware, outside play is very much part of the Nursery morning.
If you require your child to wear a cycle helmet during bike and trike riding, could you please state this in writing to the Supervisor and supply a cycle helmet clearly labelled with your child’s name.
Photographs
For Publication
Occasionally, events are held to which the Press are invited and photographs are taken for publication with the names of the children.
I give permission for my child’s photograph to be taken Y / N
I give permission for my child’s photograph to be published Y / N
I give permission for my child’s name to be published Y / N
For Personal Files
In order to celebrate the children’s work and play we take photos throughout the day. When printed, these are enclosed in the children’s personal files. Occasionally these photos contain images of more than one child.
If you do not want an image of your child to appear in another child’s file, please advise the supervisor in writing.
Parental Agreement
1. In the event of an accident/illness I agree to emergency medical attention/treatment being sought for my child.
2. I understand that fees will be invoiced at the beginning of each term and are due for payment within 14 days. I also understand that I must give 1 term’s notice of withdrawal.
3. I understand that Benson CE Primary School disclaims all liability in negligence or otherwise for any damage caused to property owned by, or in the possession of, any child or connected family member whilst that child is in the care of and/or under the control of the aforementioned Pre-school.
4. I understand that if my child is not collected at the end of the session, every effort will be made to contact all persons listed on this form and that if, after 60 minutes from end of session, Nursery has been unable to contact anyone, staff will contact Social Services for assistance. Late fees will also be payable if authorised adults are repeatedly late in collecting children.
5. I agree to abide by School policies and procedures and understand that information may be shared without my consent.
6. I understand that these policies may be open to review and that I will be informed of any changes made to the policy. Up-to-date policies are available on the School’s website.
7. I confirm that the information given above is correct to the best of my knowledge.
Signed (Mother) ……………………………………………Print Name ………………………………………………… Date……………..
Signed (Father) …………………………..…………….. Print Name ………………………………………………… Date ……………..
Appendix
Parental responsibility - what is it and who has it?
Definition
Parental responsibility is a concept that replaced the idea of 'parent rights'. It was introduced by the Children Act 1989 and is defined in Part 1 Section 3 (1) as:
...'all the rights, duties, powers and responsibilities and authority which by law a parent of a child has in relation to the child and his property.'
This is also extended to anyone who is a guardian of a child in certain circumstances.
Parental responsibility cannot be surrendered or transferred to someone else. It can only be ended on application to the Court by the person with parental responsibility or, with the Court's consent, by the child.
Many people refer to 'Parental Responsibility' simply as 'PR'.
Who has parental responsibility?
· The birth mother of the child.
· The natural father if he was married to the child’s mother at the time of the child's birth; this does not normally end if the parents separate.
· Anyone who has a Residence Order in force in respect of a child he/she is currently looking after.
· Adoptive parents.
· A parent who was not married to the child's mother, but who has acquired PR through a written agreement with the child's mother or through a Court Order.
· A step parent who has formally adopted the children of his spouse where he is not the natural father.
Who does not have parental responsibility?
· The father of a child who is not married to the child's mother and who has not sought through agreement with the child's mother or through the Court to acquire Parental Responsibility.
· Grandparents or other relatives.
· Step parents who have not formally adopted the child.
Implications for day care settings
· On registration, it is important to know who has PR for the child.
· Only the parent with PR can register a child in a provision and sign consent forms, including for medical treatment.
· Children may be collected from the setting by someone who does not have PR with consent of the parent who does.
· Divorced parents retain equal PR and one can only declare the other must not collect the child if there is a Court Order to substantiate it in the absence of any amicable agreement between parents.
· Where unmarried parents separate, the mother retains PR, but the father only retains PR if he acquired it by the mother's consent or a Court Order. Again, only a Court Order can decide who may or may not collect a child from the nursery where there is no amicable arrangement made between parents.
· Where the father did not have PR, the mother may declare that the father cannot collect the child.
NB - for fathers who do not have PR, but have care of the child, the law accepts that they may 'do what is reasonable in all circumstances of the case for the purpose of safeguarding or promoting the child's welfare'. (S3.5 (a)(b).
Information sourced from Pre-school learning alliance 2005
Equalities monitoring form – to be completed by the provider
Ethnicity, where collected, should be recorded according to the following categories:
White – British§ Irish
§ Traveller of Irish Heritage
§ Gypsy/Roma
§ Any other white background
Mixed – White and Black Caribbean
§ White and Black African
§ White and Asian
§ Any other mixed background
Asian or Asian British
§ Indian
§ Pakistani
§ Bangladeshi
§ Any other Asian background
Black or Black British
§ Caribbean
§ African
§ Any other Black background
Chinese
§ Chinese
Any other ethnic background
· Please state ______
A child’s learning difficulties and disabilities status should be recorded according to the following categories:
No special educational needEarly Years Action
Early Years Action Plus
Statement
Providers should refer to the SEN Code of Practice for an explanation of the terms above.