Let’s grow together.Interested in our Nursery? Fill out our admission form online or Download our PDF and we will be in touch shortly! We can't wait to hear from you! admission form (PDF Download) Our Online Form How did you hear about us? * Facebook Toddleabout Instagram Google Local Business Word of Mouth Child’s full name: * First Name Last Name DOB * MM DD YYYY Gender: Male Female Other Prefer not to say Language: * Nationality: Primary Contact - Parent/Guardian 1 * First Name Last Name Home Address: * Phone * (###) ### #### Occupation: Parent/Guardian 1 Relationship to Child: * Email 2. Parent/Guardian 2 First Name Last Name Relationship to Child: Home Address: Phone * (###) ### #### Occupation: Parent/Guardian 2 Email * Additional Emergency Contact * First Name Last Name Phone * (###) ### #### Relationship to Child: Alternate Phone Number: (###) ### #### People Authorized to Collect the Child / Password: Name(s), Relationship to Child, and Contact Information: Previous nursery or childminder (###) ### #### Phone (###) ### #### How long was the child attending the previous nursery or childminder? Previous key person’s name: Term Time Full Time What funding do you require? 15Hrs 30Hrs I don't need funding Monday Morning (8.30am-1pm) Afternoon (1:00-5:30pm) School day (8.30am-3pm) Tuesday Morning (8.30am-1pm) Afternoon (1:00-5:30pm) School day (8.30am-3pm) Wednesday Morning (8.30am-1pm) Afternoon (1:00-5:30pm) School day (8.30am-3pm) Thursday Morning (8.30am-1pm) Afternoon (1:00-5:30pm) School day (8.30am-3pm) Friday Morning (8.30am-1pm) Afternoon (1:00-5:30pm) School day (8.30am-3pm) When are you looking to start? * MM DD YYYY Health & Medical Information Family Doctor Details * GP's Name First Name Last Name GP’s Tel. No: * (###) ### #### GP's Address/Practice Address 1 Address 2 City State/Province Zip/Postal Code Country *Tick if these are in place for your child: EHC (Education Healthcare) SEND Support Plan Please, specify any special needs, disabilities or special support required by your child at nursery: Child’s Medical History | Does your child have any diagnosed medical conditions? * Yes No If yes, please specify: . Does your child take any regular medication? * Yes No If yes, please specify: . Does your child have any allergies (food, medication, environmental)? * Yes No If yes, please detail: Does your child have any dietary restrictions? Yes No If yes, please specify: * Has your child had any hospitalisation's or surgeries? * Yes No If yes, please detail: Does your child have any dietary restrictions? * Yes No If yes, please specify: . Vaccination status : please list Vaccines had * Emergency Medical Treatment * In the event of an emergency, do you give permission for your child to receive medical treatment? Yes No Developmental and Social Information Does your child have any specific developmental needs? Yes No If yes, please specify: Toileting Is your child fully potty-trained? Yes No Describe any assistance they may require in the restroom: Eating Habits Does your child eat independently? Yes No Are there foods you do not allow your child to consume? . Is there any allergy, intolerance or special diet? Yes No If yes, please specify: Sleeping Patterns * Does your child require a nap during the day? Yes On Do they have a comfort item (e.g., blanket, toy) for napping? Yes No Language and Communication: * Does your child communicate well with other children and adults? Yes No Do they require any support with speech or language? Yes No What celebations are imortant for your family? Social Skills How would you describe your child’s interaction with other children? Do they play independently, or do they prefer playing with others? * independently Playing with others Both Unsure Does your child participate in group activities? Yes No Unsure Behavior and Self-Regulation * Are there specific strategies that help your child calm down when upset? Does your child show any challenging behaviors we should be aware of? Permissions and Consent * Consent for Outings .Do you give permission for your child to participate in supervised local outings (e.g., nearby parks)? Yes No Photographic Consent Do you allow the nursery to take photos of your child for use in internal observations or nursery materials? Yes No Do you consent to the nursery taking photo and video content of your child for use in social media and marketing materials? (Please note, children’s faces will not be publicly shown, and modesty will always be protected.) Yes No Thank you filling in our Admissions form! We’ll be in contact soon x
