How did you hear about us?
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Facebook
Toddleabout
Instagram
Google
Local Business
Word of Mouth
Child’s full name:
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First Name
Last Name
DOB
*
MM
DD
YYYY
Gender:
Language:
*
Nationality:
Primary Contact - Parent/Guardian 1
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First Name
Last Name
Home Address:
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Phone
*
(###)
###
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Relationship to Child:
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Email
2. Parent/Guardian 2
First Name
Last Name
Relationship to Child:
Home Address:
Phone
*
(###)
###
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Email
*
Additional Emergency Contact
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First Name
Last Name
Phone
*
(###)
###
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Relationship to Child:
Alternate Phone Number:
(###)
###
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People Authorized to Collect the Child / Password:
Name(s), Relationship to Child, and Contact Information:
Previous nursery or childminder
(###)
###
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Phone
(###)
###
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How long was the child attending the previous nursery or childminder?
Previous key person’s name:
What funding do you require?
Monday
Tuesday
Wednesday
Thursday
Friday
When are you looking to start?
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MM
DD
YYYY
Health & Medical Information Family Doctor Details
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GP's Name
First Name
Last Name
GP’s Tel. No:
*
(###)
###
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GP's Address/Practice
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
*Tick if these are in place for your child:
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?
*
If yes, please specify:
. Does your child take any regular medication?
*
If yes, please specify:
. Does your child have any allergies (food, medication, environmental)?
*
If yes, please detail:
Does your child have any dietary restrictions?
If yes, please specify:
*
Has your child had any hospitalisation's or surgeries?
*
If yes, please detail:
Does your child have any dietary restrictions?
*
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?
Developmental and Social Information
Does your child have any specific developmental needs?
If yes, please specify:
Toileting
Is your child fully potty-trained?
Describe any assistance they may require in the restroom:
Eating Habits
Does your child eat independently?
Are there foods you do not allow your child to consume?
. Is there any allergy, intolerance or special diet?
If yes, please specify:
Sleeping Patterns
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Does your child require a nap during the day?
Do they have a comfort item (e.g., blanket, toy) for napping?
Language and Communication:
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Does your child communicate well with other children and adults?
Do they require any support with speech or language?
What celebations are imortant for your family?
Do they play independently, or do they prefer playing with others?
*
Does your child participate in group activities?
Does your child show any challenging behaviors we should be aware of?
Permissions and Consent
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Consent for Outings
.Do you give permission for your child to participate in supervised local
outings (e.g., nearby parks)?
Photographic Consent
Do you allow the nursery to take photos of your child for use in internal
observations or nursery materials?
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.)
