Wisbech St Mary Pre-school Churchfield Way, Wisbech St Mary
Wisbech, Cambs, PE13 4SY
Charity No:-1028194
Tel:- 01945 411864
Registration Form
Child’s details
Child’s first name(s) / SurnamePreferred Name
Child’s full address
Gender / Date of birth / (Child’s birth certificate will need to be seen as proof)
Family details
Names of people whom the child lives with:
Siblings name & Date of birth:
Parent/Carer 1(including emergency information):
Parent/carer full name
Relationship to child
Daytime/work telephone / Mobile
Home telephone / Email
Home address
Work address
NI Number ______Date of Birth ______
Does this parent have parental responsibility for the child? Yes □ No □ (Child’s full birth certificate will need to be seen as proof)
Contact details 2 (including emergency information):
Parent/carer full name
Relationship to child
Daytime/work telephone / Mobile
Home telephone / Email
Home address
Work address
NI Number ______Date of Birth ______
Does this parent have parental responsibility for the child? Yes □ No □ (Child’s full birth certificate will need to be seen as proof)
Emergency Contact Persons other than parent(s) authorised to collect the child (Please note this personmust be 17 years of ageor older. Please note that if the authorised person is not the person who normally brings/collects your child from setting, they will need to know the password, and the setting MUST have been notified by the responsible parent prior to collection of the child. If the Pre-school staff have any doubts they will not allow your child to leave with the person without being able to contact yourself and/or a trusted family member first)
Please include a minimum of one (Must be local)
Password for the collection of child by authorised persons ______
Name / Relationship to child / Day time telephone / Mobile / Email / Address
Other person(s) with legal contactTo be completed where those persons with parental responsibility are separated and an S8 Order is in place.
Name
Address
Contact telephone numbers
Relationship to child
What are the contact arrangements that we need to be aware of? including anyone who is not allowed to collect your child due to legal reasons. (relevant proof will need to be seen)
We may carry out home visits as well as open days and introductory sessions to ensure that children have the best start in their pre-school life.
Would you like a Home Visit prior to your child starting Wisbech St Mary Pre-School Yes No
Please read our home visit policy for more details.
2
About your child: The following information will tell us a little more about your child. As your child settles with us, we will establish their starting points through observation and further conversation with you.
Name/address of settingName of keyworker
Dates attended/left setting
Does your child have previous experience of attending a childcare setting? If so, please specify:
Name/address of settingName of keyworker
Day(s) attend
Will your child be attending another setting while attending Wisbech St Mary Pre-School? If so, please specify
Does your child have any distinguishing marks ie Mongolian blue spot, scar, birth mark etc? Yes □ No □
If yes please give details ......
Health and developmentIf your child is aged three years or over, does he or she have difficulty with any of the following: / Yes
Please tick / No
Please tick
Speaking and communicating
Listening and attending
Understanding simple instructions
Eating and drinking
Sitting and sharing a book
Walking and climbing
Rolling a ball
Holding a crayon
Socialising with adults and other children
Using the toilet
Putting on their coat, shoes and socks
Please provide at introduction the ASQ3 form issued to you by your health visitor, to enable the setting to complete necessary development assessments. 3
Has your child received the following immunisations?Please confirm and provide date of immunisations given.
Two months old / 5-in-1 (DTaP/IPV/Hib) vaccine -diphtheria, tetanus, pertussis (whooping cough), polio and Haemophilus influenzae type b (Hib). / Yes □ No □ / Date:Pneumococcal (PCV) vaccine. / Yes □ No □ / Date:
Rotavirus vaccine. / Yes □ No □ / Date:
Three months old / 5-in-1 (DTaP/IPV/Hib) vaccine, second dose - diphtheria, tetanus, pertussis (whooping cough), polio and Haemophilus influenzae type b (Hib). / Yes □ No □ / Date:
Meningitis C vaccine. / Yes □ No □ / Date:
Rotavirus, second dose. / Yes □ No □ / Date:
Four months old / 5-in-1 (DTaP/IPV/Hib) vaccine, third dose - diphtheria, tetanus, pertussis (whooping cough), polio and Haemophilus influenzae type b (Hib).
/ Yes □ No □ / Date:
Pneumococcal (PCV) vaccine, second dose. / Yes □ No □ / Date:
Between 12 and 13 months old / Hib/Men C booster - Haemophilus influenza type b (Hib), forth dose and meningitis C, second dose. / Yes □ No □ / Date:
MMR vaccine – mumps, measles and rubella. / Yes □ No □ / Date:
Pneumococcal (PCV) vaccine, third dose. / Yes □ No □ / Date:
Two to three years / Flu vaccine / Yes □ No □ / Date:
Three years and four months or soon after / MMR vaccine, second dose – mumps, measles and rubella. / Yes □ No □ / Date:
4-in-1(DTaP/IPV)pre-school booster -diphtheria, tetanus, pertussis (whooping cough) and polio. / Yes □ No □ / Date:
Two year old progress check – children aged 24 – 36 months
If your child is aged between 24-36 months, have they already had a two year old progress check or an ASQ3 completed? Yes □ No □ If yes, please bring these with you at introduction, along with your child medical record book (red book).
Setting/health visitor completing check (print name):-
Date Signature / Date completed
Does your child have any ongoing medical conditions? If yes please specify.
______
If yes, please specify which external agencies are involved e.g. Paediatrician, Consultant, Dietician, Speech and Language Therapist, etc:
Does your child require a health care plan? Yes □ No □ (Please delete as appropriate)
Does your child require or have a Common Assessment Framework (CAF)/Early Help Assessment (EHA) in place?
Yes □ No □ (Please delete as appropriate) 4
Does your child have any special needs or disabilities? If so, please specify:
A child’s learning difficulties and disabilities status should be recorded according to the following categories: Are any of the following in place already for your child
No special educational need / □
Early Years Action / □
Early Years Action Plus / □
Statement of Special Educational Need (EHC plan) / □
Providers should refer to the SEN Code of Practice for an explanation of the terms above.
What additional support will he/she require in our setting?
Is your child known to have any allergies or food intolerances? If so, please specify, and give details of any medical requirements.
Any other concerns:
Details of professionals involved with your child/family
GP
Name / Telephone
Address
Health Visitor (if applicable)
Name / Telephone
Address
Social Care Worker (if applicable)
Name / Telephone
Address
5
What is the reason for the involvement of the social care/locality department with your family (if involved)? NB If the child has a child protection plan, make a note here, but do not include details. We will ensure these details are obtained from the social care worker named above and keep these securely in the child's file. Please note this form is confidential and information will not be disclosed unnecessarily.
Dentist (if applicable)
Name / Telephone
Address
Any other professional who has regular contact with the child
Name 1 / Role
Agency / Telephone
Address
Name 2 / Role
Agency / Telephone
Address
Name 3 / Role
Agency / Telephone
Address
Equalities monitoring form
Ethnicity - Gathered for monitoring purposes only. Parents are not obliged to complete this data.
White British / □ / Pakistani / □
White Irish / □ / Indian / □
Traveller/Irish heritage / □ / Bangladeshi / □
Gypsy/Roma / □ / Chinese / □
Black British / □ / Chinese other / □
Black African / □ / White and Black Caribbean / □
Black Caribbean / □ / White and Black African / □
Black Other / □ / White and Black Asian / □
Other please state / 6
Cultural background
How would you describe your child's ethnicity or cultural background?
What is the main religion in your family (if applicable)?
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?
Would you wish to share your knowledge/cultural background within a session at the Pre-School Yes No
What language(s) are spoken at home? ______
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 / □ / No / □
Does your child need a bilingual support plan? Yes No If yes please speak to your childs key worker to discuss how we can work together to support your child. / □ / No / □
General information
What is your child’s usual sleep pattern?
Does your child have a pacifier i.e. dummy or thumb? / Yes / □ / No / □
Does your child have a special toy or object they might bring with them? / Yes / □ / No / □
(Please delete as appropriate)
What activities does your child enjoy doing at home, i.e. drawing or cooking?
What other information is important for us to know about your child? For example, what they like, or what fears they may have, or any special words they use and how does your child like to be comforted when they are upset?
7
Key persons - Information for parents
Each child joining the setting will have a key person appointed to them, I am your child’s key person. It will be primarily 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, and/or situations change. You will be notified of these changes if/when they occur. Your child’s key person can be your first point of contact for anything you wish to discuss about your child.
Your child’s key person will be
Your child’s key person buddy will be
To be completed by the setting
Date starting
Days and times of attendance
Are any fees payable? If so, note here
Has the settling-in process been agreed? Yes □ No □ (Please delete as appropriate)
If no, please specify:
Additional Information
If you have any preference to which sessions you are wishing your child to attend, please indicate this in the table below.
Session / Monday / Tuesday / Wednesday / Thursday / Friday
AM
PM
As we will endeavour to accommodate your request, please be aware that this is not always possible.
Please indicate if your are eligible for 30 hours free childcare Yes No
Please indicate if your child is in receipt of ‘funded 2 funding’ Yes No
8 Policies and procedures
I have access to and will adhere to all policies and procedures provided by Wisbech St Mary Pre-School.I am in full knowledge that If I have any queries I am encouraged to speak to a member of staff. I understand the Information Sharing Policy, and I understand that there may be circumstances where information is shared with other professionals or agencies without my consent.
Signed / Date
Printed name
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 name
Signed / Date
I understand that any carer who suspects that a child in his/her care may have been abused/neglected or have major concerns regarding that child’s wellbeing, has a duty to report this to the Social Care Duty team.
Parents Name ______-
Signed ______Date ______
[For group provision:]
Name of key person
Signed / Date
Name of manager
Signed / Date
Date of first review
9
PERMISSION SLIP
During the year, there will be several things for which we need your permission.
Please tick the boxes and print name below if you agree to your child being included.
Yes / NoBeing photographed for the use in Child’s personal and pre-schools portfolio of work /
Being photographed for possible inclusion in a newspaper article
Being photographed or videoed by a member of staff or student for display in school
Being photographed or videoed by a member of staff or student for inclusion of work at College or University.
Being interviewed by a member of staff or student for College or University course work
Being photographed in a group situation, a copy of which may go home in another child’s report.
Being videoed of photographed in a group activity by another child’s family.
Allowed to be administered a plaster (Hypoallergenic)
Cooking/ baking/ preparing and tasting food etc
Going for walks to explore the local environment, e.g. Post Office, Shop etc
To apply Suncream (child’s own provided from home)
Allow a member of staff to assist you on investigation of Headlice
Allow to participate in a range of sensory activities eg Body paint, Shaving foam etc
I give consent to my child receiving any medical treatment what is urgent and necessary.
I give consent for my child to participate all activities related to Forest School, including toasting marshmallows, toileting outside, fire lighting etc
I will adhere to the parent contract
I will adhere to all the settings Policy and Procedures
I understand that Wisbech St Mary Pre-School will follow all safeguarding and Child Protection policies/ procedures with regard to my child, including any referrals that they feel necessary.
I understand and agree to my childs information being shared with other professionals where deemed appropriate.
Print name: ………………………………......
Sign Name ......
Date ……………………
10
Agreed guidelines, consent, permission for accessing and using
Tapestry ‘Online Learning Journal’
I give permission for Wisbech St Mary Pre-school to create an online Tapestry Learning Journey for
……………………………………………………………………………………………... (name of child).
The e-mail address I would like use for this account, so I have access to my child’s Learning Journey is
…………………………………………………………………………………………… (Provide your e-mail address)
If you do not have access to e-mail please tick this box and you will be able to view your child’s learning Journey using school equipment during specific times throughout the year.
If at any time you experience any difficulties accessing your child’s learning journal, please speak to a member of staff.
As a settling we may take photographs for a number of reasons whilst your child is with us:
- to document what they enjoy doing;
- to record their learning and development progress
- to include in learning journals
- to record special events and achievements
- A learning journal will be used to reflect your child’s time at Pre-school. It will include photographs of your child at play and/or with other children.
- To comply with the Data Protection Act 1998, we need your permission before we can photograph or make any recordings of your child.
As a parent/carer I will;
consent to photographs/videos of my child being taken by staff at Wisbech St Mary Preschool, and I consent to photographs containing my child’s image being included in other children’s learning journals.
agree to NOT share, download or print any images that are posted on Tapestry of my own child(ren), and also those images that may include other children from the setting, via social media eg Twitter, Facebook, Instergram,etc
Complete the ‘All About Me’ section on my childs home page (accessible through Tapestry’s web page)
Will actively access my child learning journal, make necessary comments, and share my childs experience from home.
Keep the login details within my trusted family.
The undersign agree to the above
Print name:______
Signature:______Date: ______11