CHILD DETAILS

* It is the Parent/Guardian’s responsibility to complete and update the information requested in this document

REGISTRATION FORM

Child’s Details
Surname: / Address:
Post Code:
Forenames:
Date of Birth:
Gender: / Preferred start Date:
Password:

(Please put a cross (x) in the sessions you require)

MON / TUE / WED / THU / FRI
Full Day
8-6
Morning
8-1
Afternoon
1-6
School Day
8 -3.30
EYFE only session
Subject to availability
Term time only / All year round

Parent/Guardian of child/ren

Parent/Guardian 1

/

Parent/Guardian 2

Full Name: / Full Name:
Full Address:
Post Code: / Full Address:
Post Code:
Home No: / Home No:
Mobile: / Mobile:
Occupation: / Occupation:
Work No: / Work No:
Email: / Email:
Relationship to child: / Relationship to child:

*Which of these parents/guardians has parental responsibility? (please circle)

BOTH Parent/Guardian 1 Parent/Guardian2

*Has any other person got parental responsibility for your child? If so please give details:

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In the event of an emergency I/we give consent of authority to seek medical advice, attention or treatment. This is on the clear understanding that I/we the parent(s)/carer(s) will be contacted at the earliest opportunity. If we are unreachable the person(s) nominated below should be contacted and informed.

Emergency Contact: / Tel:
Relationship: / Mob:

*In the unlikely event that neither parent 1nor parent 2 are able to collect the child, please state the name and contact details of a nominated person who we should contact

(Please note that it is your responsibility to inform the nominated person of an agreed password with the nursery. Without the password, we are unable to release the child into their care)

PARENT’S AGREEMENT

I/we______(full name) of

______(full address)

The legal parent(s)/guardian(s) of______

born on______have read and understood the Terms and Conditions, and confirm that I/we accept these terms as stated, including the Terms of payment, and hereby state my/our wish to admit my/our child to ActiveKids Nursery, 8 West Way, Hove, BN3 8LD.

In addition, I/we understand that the nursery has legal obligation to report any concerns regarding the welfare of children to the relevant regulatory bodies. We also understand any safeguarding concerns have an obligation to be reported to the relevant parties.

Signed Parent/Guardian 1______Date______

Signed Parent/Guardian 2______Date______

Here at ActiveKids for security reasons we do use CCTV.

Data Protection Act 1998

The information given to Active Kids in this document will be processed only by Active Kids for the purpose of considering your child’s place at the nursery. If your child is offered a place, these forms and the information given may be retained for up to 6 years after the end of your child’s attendance at the nursery. Otherwise this form will only be retained for as long as it is required in connection to your child’s place at the nursery. By signing this form you give us your express consent to retain and process the information contained.

MEDICAL DETAILS

Child’s Name: / Date of Birth:
Doctor’s Name: / Tel:
Address:
Health Visitor’s Name: / Tel:
Address:
Support Agencies:*if yes, please specify
(this includes but is not limited to Social services/ Child protection plans or any other agencies) / Tel:
Has your child ever been subject to a child protection plan? Or had any involvement with social services (if yes please explain, this can be in person)
Yes/No
Does your Child have any Dietary Requirements? / Yes/No (please circle)
Comments:
Does your child suffer from any allergies? / Yes/No (please circle)
Comments:
Does your child need any medication whilst on nursery premises? / Yes/No (please circle)
Comments:
ADMINISTERING MEDICATION
I/we give consent for the nursery to administer any of the items that I/we have listed above.
Signed Parent/Guardian 1______Date______
Signed Parent/Guardian 2 ______Date______

PARENTAL CONSENT FORM

ROUTINE OUTINGS
Child’s Name: / Date of Birth:
I/we agree to the above named child being taken on routine outings during the ActiveKids Nursery opening hours. This may include use of the minibus.
Parent/Guardian Name:
Signed: / Date:
APPLICATION OF SUN CREAM
Child’s Name: / Date of Birth:
I/we agree to the above named child having sun protection applied as and when required by a member of staff of ActiveKids Nursery. (Please ensure this is provided)
Parent/Guardian Name:
Signed: / Date:
PHOTOGRAPHS
Child’s Name: / Date of Birth:
I/we agree to the above named child to being photographed by any member of staff at ActiveKids Nursery. I /we are aware that pictures of my child might be use around the ActiveKids Nursery classrooms/Newsletters or on the ActiveKids nursery website and Facebook.
Parent/Guardian Name:
Signed: / Date:
NAPPIES AND WETWIPES (if applicable)
Child’s Name: / Date of Birth:
I/we agree for the above named child to have their nappy changed and apply a nappy cream when requiredby a qualified member of staff.
Parent/Guardian Name:
Signed: / Date:

You are welcome at any time to see our policies and procedures within the setting. This includes but is not limited to: Illness and sickness policy, Safeguarding, Admissions, Behaviour and Play and Learning. Please just ask for copies.

LIQUID PARACETAMOL
Child’s Name: / Date of Birth:
I/we understand that if our child is unwell we will keep them at home.
*Please note any child who requires paracetamol to come to nursery is likely to recover quicker if at home
However if in nursery and in the case of an emergency e.g. fast raising temperature, parent being more than 20 minutes away, unable to contact parent
I/We give permission for ActiveKids to administer the medication
Parent/Guardian Name:
Signed: / Date:

*Please note if your child is unwell or has any infectious illnesses then we do advise you keep them home for at least 24 hours or until the guidelines state (e.g. chicken pox is 5 days from the onset of rash).

This is not only to protect the children and staff within the nursery but also support the welfare of your child.

SHARING INFORMATION
Child’s Name: / Date of Birth:
There are times as a setting where we need to share information with other agencies. This is not only to support in your child’s development but may also be to ensure the safety of your child. With any safeguarding concerns we have a duty to report these to the relevant agencies to ensure the welfare of your child.
Signing below means you understand our duties as a nursery and are aware we may need to share this information as requested.
Parent/Guardian Name:
Signed: / Date:
SHARING INFORMATION – PHOTOS
Child’s Name: / Date of Birth:
We welcome professionals from other sectors into the nursery – such as a sports coach, Story tellers and Long, Tall Silly. There are times where they request to use our photos in promotional materials.
The photos will be taken on a nursery Camera and sent by us to the individuals. If you consent to this happening please sign the agreement below.
Parent/Guardian Name:
Signed: / Date: