Ladybird Preschool Registration Form

The Pavilion, Blackburn Leisure, Prescott Avenue, Skillings Lane, Brough, HU15 1BB

e-mail: web site: Telephone: 01482 669628

Safeguarding Golden Number 01482 395500

Section 1

About your child:

First Name / Middle name / Surname

Has or is your child known by any other name: ______

Preferred name for Ladybird use: ______

Address: ______

______

Post Code:______Home telephone : ______

Date of birth: ______

Gender: m/f (delete as appropriate)

Full Birth Certificate supplied: YES/NO (A4 size with parents address and occupations)

Name of parent/carer with whom the child lives: / Name of parent/carer with whom the child lives:
Date of birth: / Date of birth:
Relationship to child: / Relationship to child:
Daytime telephone: / Daytime telephone:
Mobile: / Mobile:
E-mail: / E-mail:
National Insurance number or NASS number (National Asylum Support Service) for funding purposes: / National Insurance number or NASS number (National Asylum Support Service) for funding purposes:
Work address and telephone number / Work address and telephone number

Name and address of any other adult with parental responsibility: (please note that even when parents are separated this includes both parents on the birth certificate)

______

______

Relationship to child: ______

Telephone: ______Mobile: ______

Does this adult have legal access to the child?

Yes /no (delete)

Other emergency contact:

Name: ______

Relationship to child: ______

Telephone numbers: ______

Other persons authorised to collect your child:

(Must be over 16 years of age)

Name: ______

Relationship to child: ______

Telephone: ______Mobile: ______

Section 2

Main language spoken at home: ______

Any other languages: ______

If English is not the main language spoken at home, will this be your child’s first experience of being in an English-speaking environment?

Yes / No / Not applicable (delete)

Religion______

Ethnicity:

(Please tick))

White - British

-Irish

-Traveler of Irish Heritage

-Gypsy/Roma

-Any other white background

Mixed – White and Black Caribbean

Section 2 continued:

-White and Black

-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

Any other ethnic background

Please state: ______

Are there any festivals or special occasions celebrated in your culture that your child will be taking part in and that you would like to see acknowledged and celebrated while he/she is in our setting? Is there anything you would not like your child to take part in whilst in the setting to support your cultural needs?

______

______

Section 3

Does your child have any special needs, disabilities or medical conditions? Any special dietary requirements? Any family customs?

Yes / No (delete)

Details:
Section 3 continued:

Does your child/family have a Social Worker/Children Center Family Support Worker?

Yes/ No (delete)

Name of Social Worker/ Children Center Family Support Worker……………………………………………………….

Does your child have any form of Early Support? Yes/No (delete)

If so what type?

Does your child have a child protection plan?

Yes/ No (delete)

Names of any other professionals involved with your child

Name:
Role:
Agency:
Telephone:

Section 4

Name and address of child’s doctor:

______

______

Telephone: ______

Section 4 continued:

Has your child been immunised against:(please refer to your child’s RED BOOK given at birth from the Health Visitor)

(Please circle)

Diphtheria tetanus whooping cough polio hibs mmr

Has your child had a two year old check with the Health Visitor?

Date:

Does your child have any special dietary requirements? Yes/ No (delete)

Details:

Does your child have any allergies? Yes/ No (delete)

Details:

Does your child take regular medication? Yes/ No(delete)

Should you need to bring in any medication it must have your child’s name clearly written on the medication along with the correct dosage.

Details:

Signature of parent/guardian: ______

Date:

Medical Attention

Should your child require medical attention, our staff will seek the help of medical professionals via the emergency services. They will endeavor to inform you immediately of this action .Our staff will not agree to any medical treatment without your consent, however in the event that we are unable to contact you we will hand decision making over to the medical professionals.

Parent/guardian signature: ______

Date:

Medical attention within the setting

Should your child have a minor accident you will be informed at the end of the session and be asked to sign to acknowledge receipt of this information. Minor wounds will be cleaned and left to dry or dressed with a sticking plaster (often for comforting support for your child).

I give permission for sticking plasters to be used on my child.

Parent/guardian signature: ______

Please note: If your child suffers from any form of sickness or diarrhoea bug then we require that your child remain away from the preschool for 48 hours after the last bout of illness.

For any other queries regarding medical matters please speak to a member of staff who will advise you following guidelines passed on to us via Ofsted, East Riding Council or the Health Service.

Medicine (both prescription and non-prescription) will only be administered to a child where written permission for that particular medicine has been obtained from the child’s parent and/or carer. The Statutory Frameworkallows you to give over-the-counter medication such as pain and fever relief or teething gel. However, you must get written permission beforehand from parents.

I do/do not give consent for my child to be given the appropriate dose of pain and fever relief (Calpol) in the event of them developing a temperature.

Parent/carer signature: ______

Date of signature: ______

Pre-existing Injuries

It is a requirement of Law and our Safeguarding Policy that should a child arrive at the setting with a pre-existing injury we must fill in the appropriate form to log the injury. This is in no way a comment on your parenting abilities but merely a tool in order to protect children and to protect staff from accusation of causing an injury.

Section 5

All information regarding your child will be kept secure and confidential, although it is our duty to inform you that at times information regarding your child may have to be shared with other childcare services, providers and educational establishments; this will be in line with the Data Protection Act 1998 and Human Rights Act 1998 (A separate form in the pack must be filled in for permission to share information)

Parent/guardian signature: ______Date:

Section 6

Photography and Videoing

Photography and videoing now plays a significant role in the day-to-day activities within the pre-school. On occasion pre-school activities and outings may be photographed or videoed, these images may be used in publicity material (on-line or print) or just kept for pre-school records.

Without your personal consent, your child will not be able to have his/her photograph taken and so may miss an activity which other children are taking part in. It may also impact on other families, as we would have to consider prohibiting cameras at pre-school performances or events, which would be a great pity.

In order to comply with the Data Protection Act 1998 we must obtain written parental consent before we take photographs.

I am / am not happy for my child to have his / her photograph taken during pre-school activities or events and for these photographs to be used in any promotional literature produced for the pre-school. I understand that these photographs may be on public display at the pre-school.

Parent/guardian signature: ______

Date: ______

Photographs will be taken to inform you of your child’s progress via your child’s learning journey and will form part of the displays within the setting. Sometimes a picture can say a thousand words and what better way to see what your child gets up to!

Section 7

When is your child due to start school?

………………………………………………………………………………...

Does your child attend any other child minder / nursery / pre-school /club / group?

Yes / No (delete)

Details:

E.g. days attending

Section 8

Whilst at pre-school your child will be allocated a key person who will be responsible for carrying out observations and assessments in relation to your child. This enables their key person to monitor their progress in pre-school and to allow them to plan effectively for your child’s development.

This will be in line with the Early Years Foundation Stage Framework, which is geared to help young children achieve the five Every Child Matters outcomes of staying safe, being healthy, enjoying and achieving, making a positive contribution, and achieving economic well-being.

Your child’s key person will be ______

Section 9

To be completed by key person / manager

Start date.

Sessions attending – Actual Hours:

Monday / Tuesday / Wednesday / Thursday / Friday

Section 9 continued:

Has the settling in process been agreed? Yes/ No (delete)

Details:

Induction visit date:
Free of charge visit (FOC) date:
Home visit date:
Start date:

Registration fee paid Yes / No (delete)

(Non – refundable)

Cancellation

Once a child is registered and booked into Ladybird the sessions are held for them. Please note that one months’ notice must be given to change or cancel sessions.

Parent/guardian signature: ______

Date:

Section 10

Behaviour policy

At all times, we will inform you of your child’s behaviour whilst in the setting.

Children will be informed daily of our basic rules:-

use your indoor voice

walk when inside

share

remember to say please and thank you

take turns

Section 10 continued:

keep tidy and pick up after ourselves

be kind to each other

coughs and sneezes – “catch it, bin it, kill it”

Consequences may be asking your child to apologise for their behaviour, discussing feelings and two minutes sat out of activities.

Our policy is to use a positive, proactive approach to behaviour by encouraging children, distracting negative behaviours and discussion about cause, consequences and feelings.

We will work together in partnership with you at all times to create the best possible outcome for your child.(Please refer to a staff member if you would like to see a full copy of our behavior policy)

Parent/guardian signature: ______

Date:

Section 11

Complaints Procedure

If at any time you have cause for concern about the care of any of the children, the safety of the premises or the practice of any of the staff employed at Ladybird Preschool you have the right to raise your concerns.

1. Please, speak to a member of staff

2. If you are not happy that the situation has been resolved then you can ask to speak to a senior member of staff

3. If you are still not satisfied that it the issue has been resolved you can take the matter up with the preschool committee.

4. If still not satisfied the issue has been resolved effectively, you have the right to ring Ofsted on 0300 1231231

We will endeavor to deal effectively and efficiently with any concerns raised; remember that any concerns or suggestions are an opportunity for us to reflect on and improve our practice.

All complaints will be recorded, signed and dated.

Section 12

Are there any other details about your child that would be relevant to aiding us with their care or any other comments you wish to make?

Form checked by:

Child’s Key Person

Signature: ______

Date:

Deputy Lead Practitioner

Signature: ______

Date:

Lead Practitioner

Signature: ______

Date:

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