Registration Form

Child’s Full Name

Name to be Called (if Different)

Address

Email Address

Home Phone Number

Mother’s Mobile Number

Father's Mobile Number

Date of Birth

Birth Certificate Checked Birth Certificate Checked Birth Certificate Checked

Racial Ethnic Origin

First Language

Person with Legal Parental Responsibility

Relationship to the Child

Address (if Different from Above)

Telephone Numbers (Day & Evening)

Person with Legal Contact (If Different From Parents)

Relationship to the Child

Address

Telephone Number (Day & Evening)

Name of Emergency Contact Persons

Relationship to Child

Address

Telephone Number (Day & Evening)

Name of Emergency Contact Persons

Relationship to Child

Address

Telephone Number (Day & Evening)

The Sharing of information Under data protection GDPR 2018: if you have anyone else other than person/s with parental responsibility, including grandparents or childminders who will be picking your child up, we require consent to share any information with the nominated persons on the pickup permission slip which is written authorisation for your child to be picked up from pre-school by someone other than the person/s with parental responsibility.

Parents or Carers Occupation:

Mother:

Father:

Please add your signature to the questions below to verify your preference.

I give consent for any person I/we nominate to share information about my/our child: I give consent for any person I/we nominate to share information about my/our child: Yes No

I give permission for information to be shared with; grandparents: I give permission for information to be shared with; grandparents: Yes No

I give permission for information to be shared with; Childminder: I give permission for information to be shared with; Childminder: Yes No

I give permission for information to be shared with my child’s health visitor: I give permission for information to be shared with my child’s health visitor: Yes No

Is your child currently or have been involved with any other professional services: Is your child currently or have been involved with any other professional services: Yes No

Health Visitor’s Name

Please Specify Which Service

New Field New Field Yes No

I/we consent for Preschool to know who may child’s doctor is and understand that if necessary information may be shared. I/we consent for Preschool to know who may child’s doctor is and understand that if necessary information may be shared. Yes No

Doctor’s Name

Address

Telephone Number

Is the preschool if required allowed to share information with either the doctor or health visitor? Is the preschool if required allowed to share information with either the doctor or health visitor? Yes No

Does your child have any medical needs ? Does your child have any medical needs ? Yes No

Does your child have any known allergies/intolerances? Details

Please detail any medical procedures that are prohibited by family religion or culture. Details.

Written consent and instruction on dosage is required for the administering of all medicines, including asthma sufferers who need to use inhalers. Does your child have their paediatric vaccinations: Written consent and instruction on dosage is required for the administering of all medicines, including asthma sufferers who need to use inhalers. Does your child have their paediatric vaccinations: Yes No

Please detail any Religious or Cultural considerations to be made when caring for your child. Details:

Corrective effective First Aid will be carried out on your child if needed; all staff have completed Lincolnshire childcare support service approved Paediatric First Aid Training. I consent to any first aid treatment being given to my child during the session Corrective effective First Aid will be carried out on your child if needed; all staff have completed Lincolnshire childcare support service approved Paediatric First Aid Training. I consent to any first aid treatment being given to my child during the session Yes No

I consent for plasters to be used on my child when needed I consent for plasters to be used on my child when needed Yes No

I consent for Sun Cream to be applied on my child when needed. Sun Cream is to be provided by parents with the child’s name on the bottle and handed to a member of staff. I consent for Sun Cream to be applied on my child when needed. Sun Cream is to be provided by parents with the child’s name on the bottle and handed to a member of staff. Yes No

Emergency professional medical help will be sought if the injury or medical condition requires. I/we consent to emergency service to be called out for my child’s medical needs. Emergency professional medical help will be sought if the injury or medical condition requires. I/we consent to emergency service to be called out for my child’s medical needs. Yes No

Any medication your child may need to be administered whilst at preschool requires written permission from the parent/carer, together with dosage; a health/care plan will then be followed. All medication including sun screen is kept in a box in a lockable cupboard in the manager’s office.

I consent for photographs of my child to be taken and used within the setting (this is in addition to those used for your child’s learning journey development records) I consent for photographs of my child to be taken and used within the setting (this is in addition to those used for your child’s learning journey development records) Yes No

I consent for my child’s photograph to be taken with other children to be used for the purpose of their and other children’s learning journeys/Tapestry online learning journal. I consent for my child’s photograph to be taken with other children to be used for the purpose of their and other children’s learning journeys/Tapestry online learning journal. Yes No

Date

NO PHOTOGRAPHS WILL BE PUT ONTO THE INTERNET, other than you agreeing to the preschool website. No commercial gain will be made of any photographs taken of your child. They are mostly used for our own promotion within the preschool and your child’s learning journey documentation. I hereby give consent for my child’s information to be held on file in compliance with the Data Protection Act 1998- and the, General data protection Regulations (GDPR) 25th May 2018. Your child’s records will be held securely within the preschool office in a lockable cupboard for three years after your child has left the setting, unless there are SEN/health and care plan records which will be kept for twenty five years. After this time your child’s records will be destroyed by shedding.

Signed

Within the preschool we like to display children’s work and have their first name only with the date of their birthday, which we put on our birthday display board. Please can you sign that you agree for these to be displayed. Within the preschool we like to display children’s work and have their first name only with the date of their birthday, which we put on our birthday display board. Please can you sign that you agree for these to be displayed. Yes No

Children’s Centre information - Do you access a children’s centre? Children’s Centre information - Do you access a children’s centre? Yes No

If yes, which children’s centres do you attend?

Please ask for details on local children’s centres who have a wide range of activities and family advice.

Preschool News Letters. We will be sending out periodic newsletters updating parents/carers on events, activities and information. Please can you indicate if you would like to receive information regarding Preschool. These are also put onto our website for you to read. Preschool News Letters. We will be sending out periodic newsletters updating parents/carers on events, activities and information. Please can you indicate if you would like to receive information regarding Preschool. These are also put onto our website for you to read. Yes No

Administration Charges. The Preschool charges a one off voluntary payment of £10.00 for your child’s learning journal. This is to be paid once a place is offered and accepted for your child. Additional Information: As the Preschool is a charity, committee, run organisation; parents/carers & grandparents who have professional attributes which you feel may support the preschool’s committee, please feel free to comment below: The Preschool will share our Privacy notice and data protection policies with you at any time.