Registration Form

Child's name *

First NameLast Name

Child's Date of Birth:*

Date

Child's age on start date: *

Ethnicity:*

Parent / guardian name (1) :*

First NameLast Name

Email*

Phone number (please add country code 0044):*

Please enter country code

Address*

Street Address

CityBorough

Postcode

Work Address:*

Company name

Address

CityBorough

Post Code

Work phone number (please add country code 0044):*

Please enter country code

Parent / guardian name (2) :*

First NameLast Name

Home Address:*

Street Address

Street Address Line 2

CityBorough

Postcode

E-mail*

Phone Number (please add country code 0044)*

Please enter country code

Work Address:*

Company Name

Street Address

CityBorough

Postcode

Please specify which days and sessions you would like to book and we will get back to you ASAP to either confirm or offer alternatives. I understand that if the requested sessions are fully booked, my child's name will be placed on the waiting list for the entry at the later date. I also understand that the sessions fee is liable to increase with effect from April each year.

Fees can be found on our website www.littlestarsn16.co.uk/fees-and-payments or by request emailing the setting on littlestars2012@yahoo.co.uk.

Book your child's nursery sessions: We require minimum of 2 full days to be booked and have to include Monday or Friday. *

	Full day
Monday
Tuesday
Wednesday
Thursday
Friday

Does your child have any allergies, special educational needs, has your child got EHCP or disabilities we need to be aware of? ( Please be aware that we require written doctor confirmation/diagnosis if your child has any dietary allergies): *

Is your child entitled to Government Childcare funded hours ? This could be 15 or 30 hours?*

Is your child on child protection plan or a child in need plan?*

When would you like your child to start? We will contact you with an alternative date if we cannot start your child on the date you have chosen.*

Date

Please give us emergencies contact numbers of any three people who we can contact if we can't contact any of the parents/guardians: Prefebly people who live short distance to the nursery and will be able to get to us withing 30 min to an hour. *

	Full Name	Address	Contact Number
1
2
3

How did you hear about us?*

Other*

Will you be willing to recommend us?*

YesMaybeNo

The Nursery will confirm in writing the availability of the requested sessions. You will then receive a Nursery Entry form nearer to the time of entry to complete and return to the Nursery.

I/We understand and agree that fees for sessions pre-booked are payable in advance every month.

We understand and agree that fees are to be paid in full for any absences with regards to child illnesses or holidays. Fees will also be charged if the nursery has to close due to unpredicted emergencies or if forced by government.

Full-time and part-time placement

I/We understand and agree that if I wish to withdraw my child from Little Stars Nursery, the deposit will be lost in place of administrative fees and costs towards a replacement.

I/We understand and agree that if I have secured a place for entry at a later date, I must give six weeks' notice in writing if I no longer require the place or a fee, equal to the placement deposit, will be due in lieu of notice.

I/We understand and agree that in the event on an accident during the Nursery day, every attempt will be made by staff to contact a parent or guardian. If this provides impossible, I/WE are giving permission to carry any immediate treatment which may be required to my/our child by a member of the team, doctor or local hospital, whichever is most appropriate.

Parent / Guardian Signature*

Signature / Guardian Signature

Registration form: