Woodentops Enrolment Form

Woodentops Enrolment Form
Enrolment Form
Child's Name *

First Name Last Name
Woodentops charge a fee per hour for those children not yet entitled to funded childcare. Invoices are sent out at the beginning of the month with payment due within 7 days. If payment is not received you are at risk of loosing your child's place at Woodentops.

I agree to pay the hourly rate.
Preferred start date *

Day Month Year
Date
Funded Hours

These are accessible for children who are entitled to 2 year old Funding, three and four year old funding.

Those children pay a contribution fee - see table below, to cover additional costs that the funded grant does not cover.

Our funded sessions are £3 for a morning session (9 am to 12pm), £3 for an afternoon session (1pm to 4pm) or £6 for an all day session (9am to 3pm). Any additional hours ie 8am to 9am, 12 to 1pm or 3pm to 4pm are charged at the usual hourly rate.
Parents need to book their child's sessions for the whole term. Please note invoices are sent out at the beginning of the month with payment due within 7 days of the invoice. If payment is not received you are at risk of loosing your child's place at Woodentops.

I understand that I am expected to pay the sessional charge for the sessions my child is booked on.

What hours would you prefer for your child?

	Monday	Tuesday	Wednesday	Thursday	Friday
8am to 9am
9 to 12
12 to 1pm
9 to 3pm
1 to 4pm Monday to Thursday only
3 to 4pm Monday to Thursday only

Signature to agree to pay fees

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Child's Primary Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Date of Birth *

Day Month Year
Date
Ethnicity *
Birth Certificate Number *
Gender *

Male Female
Who does your child normally live with? *

Both parents Parent 1 Parent 2 Carers/ Grandparents
2 year old Funding Unique CPEI Number
30 hour Funded Code
An 11 digit number that working parents apply for to entitle them to 30 hours funding.
Parent 1/ Carer 1 name *

First Name Last Name
Does parent 1/ carer 1 have parental responsibility? *

Yes No
Parent 1 / Carer 1 Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Parent 1 telephone number *
Parent 1 / Carer 1 National Insurance Number *
Parent 2 / Carer name *

First Name Last Name
Does parent 2/ carer 2 have parental responsibility? *

Yes No
Parent 2 / Carer 2 Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Parent 2 telephone number *
Parent 2/ Carer 2 National Insurance Number *
Parent 1 email *
example@example.com
Parent 2 email *
example@example.com
Which Immunisations has you child had? Please tick all that apply to your child. *

6 in one vaccine at 8, 12 and 16 weeks old Rotavirus vaccine at 8 and 12 weeks old MenB vaccine at 8 and 16 weeks o Pneumococcal at 12 weeks Hib/MenC at 1 year MMR at 1 year Pneumococcal at 1 year MenB at 1 year Flu vaccine from 2 years old- annually MMR at 3 years and 3 months 4 in 1 preschool booster
Do you give consent for us to give your child their prescribed medicines as and when instructed by yourselves? *
A medication form will need to be filled in and signed by parents with clear method of administering the medication.
Consents- I agree for my child to :- please tick all that you agree to *

Have First Aid treatment Have Emergency treatment- 999 Have Factor 50 sun cream applied when needed Have Zoono hand sanitiser applied on arrival to Woodentops Use alcogel if needed. Be given their own prescribed medicines, by your Dr, as long as you have signed to agree that they can be given Have photos taken to be added to your child's Woodentops Journey Be added to the Famly App
What medical conditions does your child have? *
Please add how we can manage your child's care at Woodentops. Please type none if they have no medical conditions. Thank you.
What allergies or sensitivities does your child have? *
Please state how we can support your child when at Woodentops. Does he/she use an epipen? Please type none if your child has none. Thank you.
Drs name and Surgery name *

Drs name Surgery and contact number
Health Visitor *

Health Visitor name Contact number
Do you give us permission to share your child's information with the 0-19 health care team? *
This is to ensure your child gets their 3.25 year old health care check.
Do you give us permission to share your child's information with other agencies such as the Education and Healthcare teams? *
This is to cover the funding forms, school admissions, school that your child is due to attend ETC.
Do you give us permission to share information with other agencies? Tick all that you agree too. *

Your childminder your future/ applied for school other preschool if sharing care/ moving preschools Central Beds SEND team if needed Healthcare team Speech and language team if needed
Dentist Name and contact number
how often does your child visit that dentist?
Do you have any professionals supporting your family at the moment? If so who are they and why?
This gives us an idea of how we can support you and your child.
What kind of diet does your child have? *

No specific dietary requirement Pescatarian-Fish Vegetarian Vegan Cultural diet No pork No beef Gluten free diet Dairy free
Please expand on your child's dietary needs. *
Data Protection As part of the GDPR (25/5/18) we collect yours and your child’s data to be able to provide care for your child. You can request any information we hold about you or your child at any time. Any information about you or your child is stored securely at Woodentops in locked cabinets. We do not share your data with anyone unless we have your specific permissions to do so- for example- schools, speech and language therapists. Please see our GDPR policy statement in the website www.woodentops-potton.com and in the policy folder in the foyer. By signing this form, you are agreeing to the use of yours and your child’s data whilst at Woodentops Preschool. *

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Security Please provide details below of other people aside from yourself/yourselves who have your permission to collect your child on your behalf. Please * each name that is to be used as an emergency contact should we be unable to reach either parent. *
Does your child attend any other childcare setting including Childminders, nursery, preschool or a nanny? If so what's their name and contact details?
Do you give us permission to work in partnership with your child's childminder, nanny, nursery or preschool? This will mean sharing information regarding your child's learning and development. This will be great for supporting your child's learning. *

Yes No
Please add the contact details of your child's other setting including your child's key persons name. *
Have you any concerns about your child's development? if so what are they?
Please provide the name, role, organisation and contact details of any professionals (Social Services, Children's Centre, Health Visitor, Home start for example) who are working or have ever worked with your family and child. *
If none please type none. Thank you.
Please add any other relevant information regarding your child
Thank you for completing this form. It will help us to support your child. Signature

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