Date Received by Family Centre

This form is available in alternative formats Date Received by Family Centre ………………………………

Year 2017/2018 EXETER UNIVERSITY FAMILY CENTRE APPLICATION / REGISTRATION FORM

PLEASE COMPLETE ALL SECTIONS IN BLOCK CAPITALS, DELETE WHERE APPLICABLE AND LEAVE BLANK IF INFORMATION IS NOT YET KNOWN- THEN RETURN THE FORM AS SOON AS POSSIBLE TO:

The Manager, University of Exeter Family Centre, Mardon Hill, Exeter University, Exeter, Devon. EX4 4TH.

Email: Enquiries during term time to: 01392 725416

PLEASE WRITE CLEARLY USING BLOCK CAPITALS IN BLACK INK.

Name of child …………………………………. Family Name…….…………………………………………..

Sex Male / Female Date of birth …………………………………………………

Nationality of child ………………… First language ………………Religion of child…………………………

Family Name of Mother ………………………...Title ……… Forename of Mother …………….………….

Nationality of Mother …………………………………….. Religion of Mother …………………………

Marital Status of Mother……………………

Nationality of Father ………………………………………. Religion of Father……………………………

Marital status of Father ……………………

Please remember to keep us informed of any change of address

Legal Parenting Status: Unless we are given notification in writing we will assume that both parents have “Parental Responsibility” and therefore have permission to deliver and collect the child

Which term are you applying for? Academic Year 2017 - 2018

Autumn [Sept – Dec] * Spring [Jan – April] * Summer [April – July] * All three *

If there is not a place for you this term would you like to apply for a place next term? Yes / No

If yes, which terms? …………………………….……………………………………………………………….

Apart from this academic year, for how many more years do you think you will want to use the Family Centre?…………..…

Please note that we need one clear term’s notice for the cancellation of any sessions or the entire place.

Parents’ Occupations [Please circle or convert to bold the appropriate categories, please complete All sections]

Please make sure that you provide photographs and introduce all the people who will be collecting your child to Nursery staff before asking them to come and collect. Nursery staff will not allow your child to leave with any one that they do not know.

Please delete any vaccinations which your child did not have.

Usual age of inoculation
in British Isles / Immunisation / Date given
2 months / Diphtheria, Tetanus, Whooping Cough, Polio, Men C, Pneumococcal Infection (PCV)
3 months / Diphtheria, Tetanus, Whooping Cough, Polio, Men C
4 months / Diphtheria, Tetanus, Whooping Cough, Polio, Men C, Pneumococcal Infection (PCV)
12 months / Hib & Men C
13 months / Measles Mumps and Rubella (MMR), PCV

Has your child ever had a fit? Yes / No, If yes please state the date(s) and assumed reason(s)…………...……

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Is there any other medical condition relating your child which we should know about?

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Please state causes of any known allergies. If caused by food please state which type? ……………………….…..

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Application for sessions

Please read the following notes and then indicate in the boxes on page 4 the occupations of both parents during the days for which you are applying. If you are not able to indicate the days you require please write below the boxes how many days you need each week. For Part time bookings, the more flexible parents can be about the days allocated the more chance you will have of securing a place. Please indicate any sessions that your child could not attend. Please note that any subsequent unwanted days must be cancelled in writing by 30 June 2016 in a letter addressed to the Manager.

Cancellations of either the entire place or some days require a clear term’s notice.

Please complete the boxes below using the appropriate code. [Combinations of care will be arranged with individual parents)

L Attending lectures/lecturing B Other set employment [must be carried during this session]

P Private study O Other employment

U Other university work H Housewife/Househusband

A Other set university work or research [must be done during this session]

PLEASE LEAVE BLANK ANY SESSIONS YOU ARE NOT APPLYING FOR

Mother / Father
Monday
Tuesday
Wednesday
Thursday
Friday

· If you are requiring a part week place, and are flexible as to use which days you can accept, then note the total number of days required each week …………………………..

THIS FORM is NOT an acceptance form so please DO NOT send money with it. You will be sent an acceptance form if a place is available. A registration fee is payable with your acceptance form when it is returned to the Family Centre. Many places become available due to cancellations.

This booking is for Family Centre term time only, i.e. 44weeks and 3 days.

We operate an optional extra week summer playscheme following on from the summer term.

Is this something you would be interested in booking? YES / NO

(There will be a booking form for this additional week around February time to confirm if you require this extra week).

If it was available would you commit and be happy to pay for 50 weeks per year (i.e. closed for a week at Christmas and Bank Holidays? YES / NO

BEFORE RETURNING THIS FORM PLEASE CHECK THAT YOU HAVE COMPLETED AS MANY SECTIONS AS YOU CAN

OFFICE USE ONLY

ACCEPTANCE FORM SENT……………………………………………………………………………………………………….……

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SESSIONS OFFERED……………………………………………………………………………………………………………………

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DATE OF ENTRY ………………………………. DATE OF LEAVING ………..………………………….