Section 4 PROFESSIONAL AGENCIES INVOLVED with YOUR CHILD

SHINY STAR NURSERY REGISTRATION FORM

Section 1. Child’s details

Child’s first name(s) / known as
Surname
Child’s full address /
Gender / Male /Female Female / Date of birth / Birth certificate seen Yes / No (circle)
Section 2. Family details
Name of parent(s)/carer(s) with whom the child lives:
(If there is a contact order, please fill in Section 2.4)
Section 2.1 Contact details 1
Parent/carer full name / Mr / Mrs / Ms / Dr
Relationship to child / Language(s) spoken
Daytime/work telephone / Mobile
Home telephone / Email
Home address
Work address / Employer/Company name
Does this parent have parental responsibility for the child? Yes/No (circle)
Does this parent have legal access to the child? Yes/No (circle)
Section 2.2 Contact details 2
Parent/carer full name / Mr / Mrs / Ms / Dr
Relationship to child / Language(s) spoken
Daytime/work tel: / Mobile
Home telephone / Email
Home address
Work address / Employer/Company name
Does this parent have parental responsibility for the child? Yes/No (delete)
Does this parent have legal access to the child? Yes/No
Section 2.3 Emergency 3rd contact: Emergency contacts must be local. (Over 14 years).
Full name / Mr / Mrs / Ms / Dr
Relationship to child
Daytime/work telephone / Mobile
Home telephone / Email
Home address
Work address / Employer/Company name
Does this adult have parental responsibility for the child? Yes / No (circle)
I give my permission for this person to collect my child at any time, without prior consent. I will inform the nursery if this changes. Signature ……………………………………….
Section 2.4 Other person(s) with legal contact
To be completed where those persons with parental responsibility are separated and an S8 Order is in place (Section 8 under Children Act 1989).
Name / Mr / Mrs / Ms / Dr
Address
Contact telephone numbers
Relationship to child
What are the contact arrangements that the setting needs to know about?
Section 2.5 Please provide a password.
We cannot let your child go with a person not known to the nursery unless you have informed us first.
For the collection of the child by an authorised person
PASSWORD:
Section 3 BACKGROUND INFORMATION
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 (circle)
If so, discuss and agree with the key person how we can work together to support your child when settling-in:
Key words
Story Card (unique story to give practitioners insightful information phonetically in childs language)
Comforter (Dummy, muslin, blanket, teddy etc).
Special comfort box (containing items from home; photos, flannel with mums perfume, toy, book)
Other
What other information is important for us to know about your child? For example, what they like, or what fears they may have, any special words they use, or what comforter they may need and when.

Section 4 PROFESSIONAL AGENCIES INVOLVED WITH YOUR CHILD

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

What is the reason for the involvement of the social care department with your family? E.g. If the child has a child protection plan, make a note here, but do not include details. Ensure these are obtained from the social care worker named above and keep these securely in the child's file

______

Any other professional who has regular contact with the child, e.g. Speech & Language therapist

Name 1 / Role
Agency / Telephone
Address
Name 2 / Role
Agency / Telephone
Address
Name 3 / Role
Agency / Telephone
Address
What special support will he/she require in our setting?
Please record a child’s learning difficulties and/or disabilities here:
No special educational need
Is there an Education Health Care Plan in place? (EHC)
Is there an Early Help Form in place? (EHF)
Other (Please state) ……………………………………………………………………………………….

Section 5 IMMUNISATION DETAILS

About your child
Has your child received the following immunisations?
(Please confirm and provide date of immunisations given)

Two months old / Diphtheria, tetanus, pertussis (whooping cough), polio and haemophilus influenzae type b (Hib).
Pneumococcal infection. / DTaP/IPV/Hib and Pneumococcal conjugate vaccine (PCV)
Yes / No / Date:
Three months old / Diphtheria, tetanus, pertussis (whooping cough), polio and haemophilus influenzae type b (Hib).
Meningitis C (meningococcal group C). / DTaP/IPV/Hib and MenC
Yes / No / Date:
Four months old / Diphtheria, tetanus, pertussis (whooping cough), polio and haemophilus influenzae type b (Hib).
Meningitis C (meningococcal group C).
Pneumococcal infection. / DTaP/IPV/Hib and MenC and PCV
Yes / No / Date:
12 months old / Haemophilus influenza type b (Hib) and meningitis C. / Hib/MenC
Yes / No / Date:
13 months old / Measles, mumps and rubella (German measles). Pneumococcal infection. / MMR and PCV
Yes/No / Date:
Three years and four months or soon after / Diphtheria, tetanus, pertussis (whooping cough) and polio.
Measles, mumps and rubella. / DTaP/IPV (or dTaP/IPV) and MMR
Yes / No / Date:
Other ______
Has the child’s health record book been seen to confirm immunisation dates? Yes/No (delete)
Section 6 MEDICAL INFORMATION
Does your child suffer from any known medical conditions or allergies, or have any special dietary needs or preferences? Yes / No
If so, please provide details:
Has a risk assessment, if required, been completed? Yes / No (circle)
Has a health care plan and agreement to administer medicine, if required, been completed? Yes / No (circle)
Does your child have any special needs or disabilities? Yes / No (circle)
If so, please provide details:

Section 7 GENERAL PARENTAL PERMISSIONS

7.1 Emergency treatment declaration

In the event of an accident or emergency involving my child I understand that every effort will be made to contact me immediately. Emergency services will be called as necessary and I understand my child may be taken to hospital accompanied by the setting manager (or authorised deputy) to seek emergency medical advice and treatment and that health professionals are responsible for any decisions on medical treatment in my absence.

Signed / Date

7.2 For inhaler / Epipens only

I give permission for a named member of staff who has been trained to administer the inhaler/Epipen or
Anapen (supplied by me) to / (name of child). The named staff are:
§ 
§ 
§ 
Signed / Date

7.3 Sun cream

I give permission for staff to administer hypoallergenic suncream to
(name of child) when necessary.
Signed / Date

7.4 Teething gel (babies)

I give permission for teething gel (supplied by me) to be administered to
(name of child) when necessary - in accordance with manufacturer’s instructions - and for staff to record its use.
Signed / Date

7.5 Calpol and Sudafed

I give permission for staff to administer paracetamol based products (e.g. Calpol) to
(name of child) in the case of a raised temperature and on the understanding that I will be making arrangements for my child to be collected as soon as possible in accordance with the setting’s procedures on the administration of medicines.
Signed / Date

Section 8 SHORT TRIP - GENERAL OUTINGS

Your child will be taken out of the setting as part of the daily activities. (Tick to give permission)

Park Play Area __ Library__ Local shops__ Short walk __
Any other outings we organise, we will notify you at the time and a consent form given.

I give permission for my child to be taken out on short trips. I understand that individual risk assessments are carried out for each type of trip or outing taken and are available for me to see as required. For any major outings, I understand I will be informed and my specific consent obtained.

Signed / Date

I would like to be contacted as a parent helper for trips or outings

Yes please ____ / No thank you ____ (please tick)

Section 9 PHOTOGRAPHS

As part of the on-going recording of our curriculum and for children’s individual development records, staff regularly take photographs of the children during their play. These photographs are used for display and for your child’s records within the setting. We are happy to provide duplicate photos of your child for you if requested. We may also record events and activities on video. Photos/videos are stored on the setting’s computer only; we only store images during the period your child is with us. If we would like to use any image of your child for training, publicity or marketing purposes, we will always seek your written consent for each image we intend to use.

I do / do not give permission for my child to have his/her photograph/video taken

I do / do not give permission for my child to appear in birthday/celebration photos given to parents (circle)

I wish to view any celebration pictures my child may be in, before being given to other parents Yes / No (circle)

Signature ______Date ______

Section 10 KEY PERSONS - INFORMATION FOR PARENTS

Each child joining the setting will have a key person appointed to them. It will be the key person’s responsibility to ensure that your child receives the best possible attention whilst in our care and to ensure that their records are kept up-to date. Your child’s key person may change as your child progresses through the setting. You will be notified of these changes. Your child’s key person is your first point of contact, however, the room leader, deputy or manager can be contacted for anything you wish to discuss about your child.

Your child’s key person will be

Has the settling-in process been agreed? Yes / No If so, detail:

To be completed by the manager or deputy manager:

Starting Date
Days and times of attendance
Are any fees payable? If so, note here
Section 11 OBSERVATIONS
Under the Early Years Foundation Stage (EYFS) standards, nursery practitioners are required to carry out regular observations and record these in the children’s individual learning journeys. These observations and records are kept in the strictest confidence and can be seen by you at any time. At times, we have students that are required to carry out observations for their coursework. Students are not permitted to include children’s names or any other personal information on an observation and supervised at all times. If you give permission for students to carry out observations, you will be given a copy of the observation(s).
Permission for written observations ______Date ______
Permission for student observations ______Date ______
Section 12 PERMISSION TO APPLY FOR EARLY YEARS PUPIL PREMIUM (EYPP)
You may also be eligible for the EYPP from the term after your child’s third birthday. This is additional funding paid to Shiny Star Nursery (as your childcare provider) to ensure we provide the best outcomes for your child. By signing the declaration below, we will automatically check your child’s eligibility as soon as they turn three. The information you provide will be used by Enfield Council to check eligibility. We will then be able to inform you whether or not you meet the criteria for the Early Years Pupil Premium. For more information on EYPP visit: www.enfield.gov.uk/eypp. This information is treated confidentially and only for the purpose of checking your eligibility.
Declaration
If two parents are living together, whether married or not, details are required from both people.
Title / Surname of parent/carer / First name of parent/carer / Date of Birth (DD/MM/YYYY) / National Insurance Number or NASS Reference Number
I agree my information can be held on Enfield Council’s confidential database and shared with my local Children’s Centre. Signature: Date: Relationship to child:
Title / Surname of parent/carer / First name of parent/carer / Date of Birth (DD/MM/YYYY) / National Insurance Number or NASS Reference Number
I agree my information can be held on Enfield Council’s confidential database and shared with my local Children’s Centre. Signature: Date: Relationship to child:
Section 13 POLICIES AND PROCEDURES
Please sign below to confirm that you have been provided with details of the setting’s policies and procedures, including the Information Sharing procedures and understand that there may be circumstances where information is shared with other professionals or agencies without your consent.
Signed / Date
Please sign below to indicate that the information given on this form is accurate and correct, and that you will notify us of any changes as they arise.
Parent 1
Signed / Date
Parent 2
Signed / Date

Section 14 LATE FEES

Please arrive on time to collect your child/ren from the nursery. If you are running unavoidably late, please call the nursery as soon as possible. The nursery will charge £10 for the first 15 minutes you are late and £5 for every 10 minutes thereafter I understand late fees will be charged

Signature ______Date ______

Section 15 FEE STRUCTURE

A registration fee of £60 is paid in advance to secure a child’s place on enrolment/registration and a deposit of £100.00 is required; 5 working days before a child can start attending the nursery. This deposit will be held on account by Shiny Star Nursery and refunded within 4 weeks of a child leaving , provided they have attended for a full six months. If the child leaves before this time, the fee will not be refunded. We require four weeks notice if a child is permanently leaving the nursery. If a child leaves the nursery without prior notice, the deposit will not be refunded.

Rates for under 3’s / Rates after 15 hours free funding
From term after child’s 3rd birthday or children on terrific twos.
(15 hours of free funding taken off)
Amount of days / Weekly Rate / Monthly rate / Amount of days / Weekly Rate / Monthly rate
1 day –
7.30am – 6.30pm / £60.50 / £262.00 / 1.5 days – one 5hr session & one 10hr session
(8am-6pm & 8-1 or 1-6) / £ Free
£7.50 to pay for meals weekly. / £ Free
2 days –
7.30am – 6.30pm / £121.00 / £524.00 / 2 days –
7.30am – 6.30pm / £48.00 / £208.00
3 days –
7.30am – 6.30pm / £181.00 / £786.00 / 3 days –
7.30am – 6.30pm / £114.00 / £494.00
4 days –
7.30am – 6.30pm / £242.00 / £1.048.00 / 4 days –
7.30am – 6.30pm / £179.50 / £778.00
5 days –
7.30am – 6.30pm / £290.00 / £1.258.00 / 5 days –
7.30am – 6.30pm / £245.00 / £1,062.00
Half day’s / For children on 15 hour funding – 3hrs per day, 5 days per week / Free
9am – 12pm for 5 days during term-time / Free
1pm – 4pm for 5 days during term-time
1 session – either:
7.30am – 1.00pm
1.00pm – 6.30pm / £38.00 / £164.00
2 sessions – either:
7.30am – 1.00pm
1.00pm – 6.30pm / £76.00 / £329.00 / ·  The weekly rate is calculated over 12 equal monthly payments.
·  Fee’s include all meals, snacks, nappies for under 2’s and nappy cream.
·  Please provide nappies for over 2’s.
·  These fees are calculated with 15 hours of free nursery entitlement taken off. This rate is applicable from the term after the child’s third birthday, or for children accessing terrific twos.
3 sessions – either:
7.30am – 1.00pm
1.00pm – 6.30pm / £114.00 / £494.00
4 sessions – either:
7.30am – 1.00pm
1.00pm – 6.30pm / £152.00 / £658.00
5 sessions – either:
7.30am – 1.00pm
1.00pm – 6.30pm / £190.00 / £823.00

FEE STRUCTURE FOR PRIVATE PAYING HOURS