YMCA Thames Gateway Children S Services REGISTRATION FORM - Romfordpreschool

YMCA Thames Gateway Children’s Services REGISTRATION FORM - RomfordPRESCHOOL

Please provide the following information so we can register your child with the YMCA children’s services department. Please write clearly and in black or blue ink.

Child’s details

First Name(s) / Surname
Date of Birth / Gender M / F
(please delete as appropriate)
Home Address
Postcode / Religion (please let us know any festivals or special occasions celebrated in your culture / religion that you would like your child to celebrate whilst with us
Languages Spoken

Password details

As part of our security system, you must provide us with a password. This ensures that when anyone other than yourself, collects your child, that we know you have authorised the collection.
Password

Sessions / days requested for your child – please tick

Parents who receive 15 hours a week of nursery funding can use this to pay for the preschool sessions. Some 2 year-olds do not qualify for any free funding.
Monday / Tuesday / Wednesday / Thursday / Friday
Morning session
(9am to 12pm)
Afternoon session / Not available yet

How do you intend to pay for these sessions?

Cash / Credit card / Free funded 15 hours of childcare per week – (not all children qualify for this) / Work based vouchers / Monthly Direct Debit (additional form required)

Contact details 1

Parent / carers first name(s) / Surname
Relationship to child
Home telephone number / Daytime telephone number
Mobile telephone number / Email Address
Home address and postcode (If different from child’s address)
Your own personal National Insurance (NI) number – we only require this number if you will be
claiming the free 15 hours of funding.

Does this person have parental responsibility for the child?
Yes / No (please delete as appropriate)
Does this person have legal access to the child?
Yes / No (please delete as appropriate)

Contact details 2

Parent / carers first name(s) / Surname
Relationship to child
Home telephone number / Daytime telephone number
Mobile telephone number / Email Address
Home address and postcode (If different from child’s address)
Does this person have parental responsibility for the child?
Yes / No (please delete as appropriate)
Does this person have legal access to the child?
Yes / No (please delete as appropriate)

Other person(s) with legal contact – to be completed where this person(s) has parental responsibility but is separated and where an S8 order is in place

Parent / carers first name(s) / Surname
Relationship to child
Home telephone number / Daytime telephone number
Mobile telephone number / Email Address
Home address and postcode (If different from child’s address)
Does this person have parental responsibility for the child?
Yes / No (please delete as appropriate)
Does this person have legal access to the child?
Yes / No (please delete as appropriate)
Please detail here the contact arrangements which the nursery must be made aware of

Emergency contact 1.Details to be used only if parents / carers named above are not available. These emergency contacts must live locally to the nursery and be over 16 years old

Emergency contact first name / Surname
Relationship to child
Home telephone number / Daytime telephone number
Mobile telephone number / Email Address (optional)

Emergency contact 2.Details to be used only if parents / carers named above are not available. These emergency contacts must live locally to the nursery and be over 16 years old

Emergency contact first name / Surname
Relationship to child
Home telephone number / Daytime telephone number
Mobile telephone number / Email Address (optional)

Medical information and Doctors details relating to the child

Doctors Name / Doctors Address / Doctors Telephone number
Please give details of any allergies your child may have, including food allergies
Please give details of any medication your child is currently taking – a separate medical form will need to be completed for each medication
Does your child have any Special Education Needs or disabilities we need to be made aware of? (If yes, please provide details). Please use a separate sheet of paper if required
Other information about your child which you think may be relevant: – do they have a social worker, is there any health or behavioural issues we should know about?
Consents / Please tick
In the event of an accident, I give my full consent for a trained member of staff to apply first aid to my child
I give permission for a member of YMCA Thames Gateway staff to apply a plaster or bandage on my child if required
I consent to my child being photographed / videoed for the purposes of general records, YMCATG website, related promotions and for use within the Pre-school
In case of emergency, I give permission for the staff to seek necessary emergency medical advice or treatment. (Please note that we will contact you immediately)
I give permission for my child to leave the YMCA nursery building with his/her group staff to attend organised trips and outings
I give permission for a member of YMCA Thames Gateway staff to apply sun cream when my child needs it. I understand that I will supply and clearly label the sun cream beforehand
I give permission for my child to have their face painted
I give permission for my child to travel in a mini-bus with suitable seating and seatbelts
I understand, and will pay for all sessions I book which are not otherwise funded

Important.We ask that you keep us informed of any changes to the details contained in this registration form. Periodically we may ask you to confirm your details for our records.

Sign______Print Name ______

Relationship to child______Date ______

To be completed by a member of YMCA Thames Gateway staff

Item / task / Checked / received by (staff member’s name) / Date checked
Child’s birth certificate checked
Immunisation form completed and returned
Direct Debit form completed and returned
Contract completed and returned
Policies and Procedures information given to parent