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REGISTRATION
FORM
| Child's Full Name: | ……………...………………….…………………… | Sex: ( M/F) |
| Home address: |
……………...………………….…………………… ……………...………………….…………………… ……………...………………….…………………… ……………...………………….…………………… ……………...………………….…………………… |
|
| Telephone: | (014839) | |
| Date of Birth | 123/123/ | or Due Date |
| Nationality: | ……………...………………….…………………… | |
| Religion: | ……………...………………….…………………… | |
| Mother's Name: | ……………...………………….…………………… | |
| Fathers Name: | ……………...………………….…………………… | |
| Profession: | ……………...………………….…………………… | |
| Work No: | (014839) | |
| Email: | jonathansandysjonathansandys@ | |
| Mobile/Pager: | (014839) |
ALTERNATIVE
CONTACT IN CASE OF EMERGENCY
| Name: | ……………...………………….…………………… | |
| Telephone: | (014839) | |
| Relationship (to your child): | ……………...………………….…………………… | |
| Child's Doctor: | ……………...………………….…………………… | |
| Address: |
……………...………………….…………………… ……………...………………….…………………… ……………...………………….…………………… ……………...………………….…………………… ……………...………………….…………………… |
|
| Telephone: | (014839) |
ABOUT YOUR CHILD
| Language spoken at home: | ……………...………………….…………………… | |
| Any allergies/illness e.g eczema: | ……………...………………….…………………… | |
| Any special diet: |
……………...………………….…………………… ……………...………………….…………………… ……………...………………….…………………… |
|
| Immunisations up to date: |
……………...………………….…………………… ……………...………………….…………………… ……………...………………….…………………… ……………...………………….…………………… |
Publicity Permission
WE DO / DO NOT want our child to appear on your website
| Date to start: | 123/123/ | |
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FULL TIME/PART TIME
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(please circle): |
If you wish your child to attend Moreton Day Nursery or Pre-School, what days would you like them to attend? (please circle):
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MONDAY
|
TUESDAY
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WEDNESDAY
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THURSDAY
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FRIDAY
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I/We agree that this application is made in accordance with the Terms and Conditions
of the Nursery, and enclose a cheque for £35.00 payable to 'MORETON DAY NURSERY SCHOOL'.
MOTHER/FATHER (please circle)
Signed: …………..………….………………..… …………..………….………………..…
Date: …………..………….………………..… …………..………….………………..…
OFFICE USE ONLY
DPS PAID: REGIS PAID:
