PINE RIVERS KINDERGARTENLTD
5 WESTERN ELMS AVENUE,
READING, BERKS. RG30 2AL
Tel: 0118 9598232
Ofsted no:EY481683
REGISTRATION FORM
Start date………………Deposit taken ...... Cash/chq/ bank
Finish Date......
Where were we recommended from …Advertisement / friend / website / yell.com/ yellow pages/ Early Years / other ………………… Please circle one.
PLEASE COMPLETE IN BLOCK CAPITALS
We require a copy of your Childs birth certificate with this form please
Name of child/children______
Known as (if different)______
Date of birth______
Home address______
______Postcode______
Email address ______
Home telephone number______
Parent’s names – Mother______
Mobile number______
Father______
Mobile number ______
Address if different from above______
______Postcode______
Please enter two contact numbers other than parents for emergencies
Name______Tel ______
Relationship to child......
Name______Tel ______
Relationship to child......
Password ......
Mother’s place of work
Telephone number______
Father’s place of work______
Telephone number______
Languages spoken at home______
Religion______
Nationality______
Names and ages of siblings______
Doctor’s name and address______
Telephone number______
Health visitor’s name______
Health visitor’s telephone number______
Please list previous settings that your child has attended
Name of setting Dates No of sessions
………………………………......
......
Any other information or comments that you require us to know......
......
......
......
......
......
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PARENTAL AGREEMENT
Mon / Tues / Wed / Thurs / FriAM / PM / AM / PM / AM / PM / AM / PM / AM / PM
All day / All day / All day / All day / All day
Funding
AM 8-11 / Funding
PM 1-4 / Funding
AM 8-11 / Funding
PM 1-4 / Funding
AM 8-11 / Funding
PM 1-4 / Funding
AM 8-11 / Funding
PM 1-4 / Funding
AM 8-11 / Funding
PM 1-4
SESSIONS REQUIRED………………………...... Please circle table below
Free Funding hours-no charges made 8-11am morning x 51-4 pm afternoon x 5
Additional hours required outside free funding hours will be charged at our hourly rate. Extra hours required ......
NAME OF CHILD………………………………STARTING FEE ………..
METHOD OF PAYMENT STANDING ORDER ,VOUCHERS , OTHER ………(please circle one)
N.B.
Fees are due even if your child is absent or on holiday, at full cost, or due to severe bad weather closure.
Fees are due on the Monday morning for the week or month, and are always payable in advance.
A charge will be incurred for any cheque returned to us by the bank.
Four weeks notice is required, in writing, when withdrawing your child or if you wish to change your child’s sessions.
The fees are revised from time to time and a notice will be placed on the notice board a month before any increase takes effect.
. All account sent to them will incur a £40 late collection fee.
- Nursery closes at 6pm -there is a late night fine system in place. From a minute after 6pm it will be £10 per every 15min.
Record Of Immunisations………………………………………………….
……………………………………………………………………………..
Medical History……………………………………………………………
……………………………………………………………………………..
Anything else you feel we should know about your child…………………
………………………………......
DECARATION I have read and understood the terms and
conditions in Pine Rivers prospectus and agree to abide by them.
MOTHER’S SIGNATURE…………………………………Date…/…/…
FATHER’S SIGNATURE…………………………………..Date…/…/…
I …………….. (Parent’s name) give Pine Rivers permission to take ……………. (Child’s name) on local outings and to the Hospital in an Emergency
PARENTS SIGNATURE……………………………….Date…/…/…
CHILD PROTECTION POLICY
Pine Rivers Kindergarten are required, by Law, to abide by the following criteria:
1.It is the duty of Pine Rivers Kindergarten to refer their concerns to Social Services if they have any cause to suspect that a child is at risk from abuse or being abused.
2.Pine Rivers Kindergarten may make a referral to Social Services without a parents or carers knowledge or consent, depending on circumstances.
3.Pine Rivers Kindergarten have a responsibility to inform Parents/Carers of any accidents or injuries a child sustains whilst in their care. It is essential that Parents /Carers inform room Leaders/Manager of any accidents/ or injuries that their child has sustained at home or elsewhere.
4.As a matter of good practice Pine Rivers Kindergarten is required to record and accidents or injuries in their accident book. Parents/Carers will be asked to read and sign this book.
I have read and understood this statement . . .
Signed ...... ( Parent/Carer )
Printed......
Dated. …./…./………..
Special Dietary Requirements Form
If your child has any dietary requirements, please fill form in , sign and date or tick box below.
My child has no dietary requirements
Full name of child......
Parents name ......
Contact number......
Date of birth......
Dietary information
Is this request for special dietary requirements the result of : (please tick)
Medical diagnosis
Religious beliefs
Personal preference
Details of dietary requirements......
......
Allergy information (where applicable)
Details of known allergy ......
Diagnosed by......
Sign ...... date......
Consent Form
For Photography and Images of Children
Dear Parent or Guardian
During your child’s time a Pine Rivers we may wish to take photographs of the activities and events going on in the nursery that may involve your child. The photographs may be used for displays around the nursery, in local press and on our Facebook or Twitter site. This is as much to keep you updated with our activities than anything else and to show you what your children are up to whilst in our care. Any filming that may be done will only be carried out with the permission of the Managing Director (Lesley Delecia) and with appropriate supervision. The children will not be named and would only be referred to by their room name (e.g Acorn’s).
Images that might cause embarrassment or distress will not be used nor will images associated with material on issues that are sensitive.
Before taking any photographs of your child, we need your permission so please could you fill in the form below to indicate you’re wishes.
You may withdraw your consent at anytime by writing to us at the above address.
Name of Child ......
Please tick the appropriate boxes:
YES I do give my consent for photos and videos of my child to be shown:
Within the nursery
On our website
On our Facebook page
In the press
In advertising
NO I do not give permission for ANY of the above.
Print Name (Parent/Guardian) ......
Signature (Parent/Guardian) ......
Date ......
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