Details of Professionals Involved with Your Child

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/ /
If you have any difficulty filling in this form please speak to a member of staff.
Child’s full name
Date of birth / Male or Female
Address of child
Parent/carer1
Who the child lives with / Parent/carer1
Who the child lives with
Full name / Full name
Address / Address
Tel no / Tel no
Work Place / Work Place
Role / Role
Work Tel no / Work Tel no
Mobile no / Mobile No
Email address / Email address
Name of parent with whom the child does not live
Name
Does this parent have parental responsibility? Yes/No (delete)
Address
Telephone Number / Mobile No. / Work No
Does this parent have legal access to the child? Yes/No (delete)
Emergency contact (should parent(s) be unavailable:
Full name / Relationship to child
Address / Tel No
Work Tel No
Mobile Tel No
Please ensure you complete the emergency treatment form attached.
Does the Child have any Siblings? YES/NO
If yes please give Name and Age, as this is a useful talking point with your child
Who will be collecting your child regularly from preschool?
Persons authorised to collect the child (must be over 16 years of age)
Name: / Tel No
Address
Name: / Tel No
Address
Name: / Tel No
Address
(We must be informed of any changes to these arrangements: Tel 01359-232736)
Will your child be attending another childcare setting alongside Norton Pre-School? Yes/ No
If yes – please give the name and the telephone number of the other setting and details of any funded sessions that will be claimed.

Details of professionals involved with your child

GP

Name / Telephone
Address

Health Visitor (if applicable)

Name / Telephone
Address

Social Care Worker (if applicable)

Name / Telephone
Address
What is the reason for the involvement of the social care department with your family?
Does your child have a child protection plan? YES/NO
Two year old progress check – children aged 24 – 36 months
If your child is aged between 24-36 months, has a two year old progress check already been completed for your child? Yes □ No □
Setting completing check / Date completed
As per the requirements of the Early Years Foundation Stage [we/I] will complete a progress check on your child between the ages of 24-36 months. [We/I] will ask you to be involved in completing the check and will discuss it with you.
Please use the box below to add any further comments/information you would like to share with us:
Comments

In accordance with our polices and procedures please can you complete the following permission form for your child:

Photographs/videos/recordings

During your child’s time at Norton Pre-School we may take photographs, videos, or recordings of your child to use in both displays and also to record your child’s development.

I/We give permission for photographs, videos and recordings of my child to be taken during their time at Norton Pre-School. I/We understand these images will be used in displays in the Pre-School and also to record my/our child’s development.

I/We give permission for photographs, videos and recordings to be taken by other parents/carers during special events such as Christmas productions, sports days and parties.

I/We give permission for photographs to be used of my child for advertising or publicity articles such as Local Newspapers, Magazines or Television.

Observations and Record Keeping

During your child’s time at Norton Pre-School, staff will make regular observations of your child and record these in their Learning Journey. These observations maybe shared with visiting professionals such as speech therapists, the Primary School teacher or Suffolk County Council support teacher/assistant.

I/We give permission for observations to be made and shared with visiting professionals where necessary.

I/We give permission for all development records held on my child at Norton Pre-School to be passed onto my/our child’s Primary School or next setting when they leave the Pre-School.

I/We give permission for Norton Pre-School Staff and students on placement to make observations on my child and to use these observations for their course work. I understand that these observations will not for any reason name or identify my child.

Visits in our local environment

The Pre-School children will have the opportunity to take part in visits within our local environment i.e. to Norton Primary School and the village hall and playing fields and play area. The children will always be accompanied by the Pre-School staff and we will ensure ratios are maintained at all times. You will receive written permission and information letters for any visits outside these areas.

I/We give permission for my child to take part in visits to Norton Primary School when accompanied by staff from Norton Pre-School.

I/We give permission for my child to take part in visits to Norton Village Hall, playing fields and play area when accompanied by staff from Norton Pre-school

Computer and internet permission

During your child’s time at the Pre-School they will be encouraged to use a computer and the internet independently. All internet access is monitored and websites have restricted access.

I/We give permission for my child to use the Pre-School computer and have access to the internet.

Sun cream authorisation

I/we authorise for staff to help or apply sunscreen to my/our child when required. I understand that this will be applied by a CRB checked member of staff only.

I will supply the pre-school with sunscreen that I wish to be used on my child.

Where my child does not have sunscreen, I authorise staff to help or apply the sunscreen held at the pre-school Ambre Solaire Kids 50+ Moisturising spray.

To my knowledge my child is not allergic to this sunscreen

Data Protection

I hereby give consent for the information in this form to be held on file in compliance with the Data Protection Act 1998.

If you are not happy to give permission for any of the above please comment in the box below, so that the Pre-School staff are able to abide by your wishes.

I have been informed of the policies and procedures file and how to access it
Signature……………………………… Staff signature ………………………….…….. Date …………….
To reduce the amount of paper that is sent home I would like to receive all letters, newsletters, etc via Email:

Yes Please/ No Thank you

Email address:
For marketing purposes please could you tell us how you heard of Norton Pre-School:
I understand that the Pre-School are obliged to share confidential information without authorisation from the person who provided it or to whom it relates if it is in the public interest. That is when:

• it is to prevent a crime from being committed or intervene where one may have been, or to prevent harm to a child or adult.
• Or not sharing it could be worse than the outcome of having shared it.

Signed Parent/Carer 1 / Date
Signed Parent/Carer 2 / Date
Is Parent/Carer 1 a legal guardian of this child / YES/NO
Is Parent/Carer 2 a legal guardian of this child / YES/NO
Sessions I would like for my child:
Monday / Tuesday / Wednesday / Thursday / Friday
Breakfast club 8am - 9am
Morning session 9am -12 noon
Lunch Club 12-1pm
Afternoon session 1pm-3pm
Afterschool Club 3pm – 4pm
Afterschool Club 3pm – 5pm
Afterschool Club 3pm – 6pm

BC-8am-9am, AM- 9am-12 noon, LC- 12-1pm, PM-1pm -3pm ASC 3pm-4pm, 3pm - 5pm or 3pm – 6pm

To be completed by the key person/manager

Date starting at / Norton Pre-School
Signed by
Taster Sessions and induction morning dates
Comments

In order for the staff to ensure that your child receives the best and most appropriate care, attention and treatment should there be an emergency in the pre-school, or out on an authorised outing, you need to complete, sign and date the declaration below.

Full name of child Date of birth

Name of parent/guardianName of parent/guardian

Please complete, sign and date the following declaration.

Declaration for emergencies

I agree to the pre-school leader (or assistant) taking necessary steps to ensure that my child

(Name of child) …………………………………………………… receives the best and most appropriate care, attention and treatment should there be an emergency or accident in the pre-school or while my child is on an authorised outing. I understand that the pre-school leader (or deputy leader) will make every effort to inform me of any emergency or accident as soon as possible after the event but that

they may accompany my child (name of child)

…………………………………………………………..

to hospital in the case of a serious accident in my absence. I give permission for the pre-school leader (or deputy leader) to authorise hospital staff to administer essential treatment until my arrival.

Signed by parent/guardian

Signed by parent/guardian

If you do not agree with any or all of the above declaration, please do not sign it but make your views known in the space below. The pre-school leader (or deputy leader) will then discuss this with you and do their best to accommodate your particular wishes.

I do not agree with the declaration and would prefer the following procedure to be followed for my child. (Name of child) in the event of an emergency.

.………………………………………………………………….

Signed by parent/guardian

Signed by parent/guardian

Equalities monitoring form – to be completed by the Pre-School

Ethnicity - Gathered for monitoring purposes only. Parents are not obliged to complete this data.
White British / □ / Pakistani / □
White Irish / □ / Indian / □
White other / □ / Asian other / □
Black British / □ / Chinese / □
Black African / □ / Chinese other / □
Black Caribbean / □ / White and Black Caribbean / □
Black Other / □ / White and Black African / □
Bangladeshi / □ / White and Black Asian / □
Other please state

A child’s learning difficulties and disabilities status should be recorded according to the following categories:

No special educational need / □
SEN action plan / □
Education, Health and Care Plan / □

Providers should refer to the SEND Code of Practice for the Early Years (2014) for an explanation of the terms above.

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At Norton Pre-School we are committed to safeguarding and promoting the welfare of children and expect all staff and volunteers to share this commitment.