FOR OFFICE USE ONLY

Registration Date………………………………

Birth Certificate Seen

SIMS HV

Start Term………………………………………

Start Date………………………………………

Class ……………………………………………

UPN No……………………………………………

Sharing, Caring and Learning Together
Dear Parents/Carers,
Your choice of early education is a very important decision. At Chalvey Nursery School you can be sure your child will be in a safe and happy learning environment with friendly and qualified staff that love caring for and teaching young children.
We provide your child a happy, warm, stimulating and secure learning environment. We aim to meet the individual needs of our children, giving them the social skills and confidence they need in their foundation years and providing them with a sound platform for transition into school life.
Ofsted have rated the quality and standards of our early years provision as Good.
CHILD’S NAME______SURNAME______
Child’s Middle Name ______Known as______
Gender: Boy Girl *DATE OF BIRTH______
* please provide a copy of the birth certificate
COUNTRY OF BIRTH______NATIONALITY______
Address______
______Post Code______
Home Tel. No______
Please give details of persons who have parental responsibility
Contact
MOTHER’S NAME______SURNAME______Priority – 1 2
Address(if different from above)______
Mobile. No______Work No ______
Email Address______
Contact
FATHER’S NAME______SURNAME______Priority – 1 2
Address(if different from above)______
Mobile. No______Work No ______
Email Address______
Status of Parents (Please Circle):
Married Divorced Single Widowed Separated Cohabiting
OTHER CHILDREN IN FAMILY
Name Date of Birth School
______
______
______
______
WHO WOULD YOU LIKE US TO CONTACT IN AN EMERGENCY (OTHER THAN PARENTS)
EMERGENCY CONTACT (1) Name______Tel no.______
Relationship to child______
EMERGENCY CONTACT (2) Name______Tel no______
Relationship to child______

NAME OF CHILD’S DOCTOR______Tel. No______

Address______Postcode______

Health Visitor______Tel. No______

Mode of Transport (please circle one that would normally be used)

Car Bicycle Public Transport Walk

Child’s Religion______Child’s First Language______

English as an additional language: Yes/No

If you have recently arrived in this country, which country did you arrive from?______
Date of arrival______Are you and your children seeking political asylum in the UK?______
Do you have refugee status in the UK?______
ADDITIONAL INFORMATION
Is there any supporting information you would like to share with us about your child e.g. health worries, allergies, speech, eyesight, hearing, challenging behaviour concerns?
______
______
______
______
______
PREFERRED SESSION – PLEASE TICK

MORNING Session 8.30am – 11.30am AFTERNOON Session 12.45pm – 3.45pm
FULL TIME* - 8.30am – 3.45pm LUNCHTIME CLUB* - 11.30am – 12.30pm
*Daily Rate for Full Day - £12 per day
*Daily Rate for Lunch Club - £4.00 per day
Childcare Vouchers accepted
We provide Free Early Learning for 2 year olds, please see a member of the office staff for more information.

Please tick the boxes below to confirm your understanding and agreement:-

I understand that my child must always be accompanied to and from the nursery

by a person aged 16 years or above.

I understand that a place is offered to me on the condition that I do not transfer my

child to another Nursery unless I move house or there are extenuating

circumstances that have been discussed with the Head Teacher.

I understand that if my child does not attend regularly, the place may be withdrawn

after extensive discussion with parents.

I understand that my child’s records will be transferred to his/her next school within

the schools’ data system.

PARENT’S/GUARDIAN’S SIGNATURE______Date ______

PARENT’S/GUARDIAN’S NAME______

Please visit our website: www.chalveynurseryschool.co.uk for more information

CHALVEY NURSERY SCHOOL

Ethnic Background Record Form (EBRF)

Child’s Name:______Class ______

Our ethnic background describes how we think of ourselves. This may be based on many things, including, for example, our skin colour, language, culture, ancestry or family history. Ethnic background is not the same as nationality or country of birth.

Please study the list below and tick one box only to indicate the ethnic background of the pupil named above.

Afghan / Hong Kong Chinese / Serbian
African Asian / Indian / Singaporean Chinese
AKAS - Kashmiri / Iranian / Sri Lankan Other
Albanian / Iraqi / Sri Lankan Sinhalese
Arab / Italian / Sri Lankan Tamil
Asian/Black / Japanese / Taiwanese
Asian/Chinese / Kashmiri Pakistani / Thai
Asian and other ethnic group / Kashmiri Other / Traveller – Irish Heritage
Bangladeshi / Korean / Turkish
Black Angolan / Kosovan / Turkish Cypriot
Black Caribbean / Kurdish / Vietnamese
Black Congolese / Latin /South/Central American Americancan / White
Black European / Lebanese / White Cornish
Black Ghanaian / Libyan / White English
Black Nigerian / Malay / White Irish
Black North American / Malaysian Chinese / White Scottish
Black Sierra Leonian / Mirpuri Pakistani / White Welsh
Black Somali / Moroccan / White Eastern European
Black Sudanese / Nepali / White European
Black and Chinese / Other Asian / White Western European
Black and any other ethnic group / Other Black / White/Any other ethnic group
Bosnian-Herzegovinian / Other Black African / White/Any other Asian
Chinese and any other ethnic group / Other Chinese / White/Black African
Croatian / Other Ethnic Group / White/Black Caribbean
Egyptian / Other mixed background / White/Chinese
Filipino / Other Pakistani / White/Indian
Greek / Other White British / White/Pakistani
Greek Cypriot / Polynesian / Yemeni
Gypsy/Roma / Portuguese / I do not wish any ethnic background category to be recorded

(Any information you provide will be used solely to compile statistics on the experiences of pupils from different ethnic backgrounds, to help ensure that all pupils have the opportunity to fulfil their potential. These statistics will not allow individual pupils to be identified. From time to time the information will be passed on to the Local Education Authority and the Department for Education and Skills (DfES) to contribute to local and national statistics. The information will also be passed on to future schools, to save it having to be asked for again).