Registration. To register a place for your child, please complete and submit the form below. Childs name * The name of your child First Name Last Name Date of birth * The date of birth of your child MM DD YYYY Home address Address * Your address Address 1 Address 2 City State/Province Zip/Postal Code Country Father Fathers name * The name of the father of your child First Name Last Name Fathers occupation Fathers mobile Fathers work phone number Fathers e-mail * Mother Mothers name * First Name Last Name Mothers occupation Mothers work phone number Mothers mobile Mothers e-mail * Email Primary e-mail Emergency Contact This is the person we will contact in an emergency if we cannot get hold of mum or dad. Emergency contact name * First Name Last Name Emergency contact phone number * Medical Doctors name * First Name Last Name Surgery phone number Medical history/allergies * Registered Hours Request Start time This is the time you wish your child to be dropped off at nursery. Hour Minute Second AM PM End time This is the time you plan on picking your child up from nursery. Hour Minute Second AM PM Day Selector checkboxs Monday Tuesday Wednesday Thursday Friday Nursery Policies Nursery Policies Checkbox * I understand that The Ascot Day Nursery request that I am familiar with their Policies and Procedures, including GDPR which are available to view at Nursery or online on www.theascotdaynursery.co.uk. Yes, I understand Photographs Checkbox * If you do not wish for your child to be photographed please inform the Nursery Manager in writing. Yes, I understand Sun Cream Consent Checkbox * I agree that The Ascot Day Nursery can use Sun cream supplied by themselves. Yes, I understand Teething Gel Consent * I agree that The Ascot Day Nursery can administer Teething gel supplied by themselves. I agree I disagree Calpol / Nurofen Consent * I agree / do not agree that The Ascot Day Nursery can administer Calpol / Nurofen supplied by themselves (we will always contact you first To check dosage). I agree I disagree Piriton Consent * I give permission for The Ascot Day Nursery to administer Piriton to my child (we will always attempt to contact your first for permission). I agree I disagree Facebook * I do/do not agree that my child’s photographs can be added to Facebook. I agree I disagree Outings * I agree that my child may be taken for outings to the play park and local walks with the appropriated supervision. I agree I disagree Withdrawal or Changes to this contract with The Ascot Day Nursery * By ticking this check box, you are agreeing to provide The Ascot Day Nursery with a full calendar months notice to any changes to your child’s registered hours and agreed start date. The full calendar month also applies, should you choose to terminate this contract with The Ascot Day Nursery. I agree I disagree EAL(Enlgish as an Additional Language) Statement * English is not our home language, but we would request that English is the language of communication at The Ascot Day Nursery and we will encourage our home language at home. We do not want our home language reinforced / encouraged at Nursery. I agree I disagree Home language * English is not our home language and we request support with our home language at The Ascot Day Nursery. I agree I disagree Safe Sleep Policy * The Ascot Day Nursery adopts a ‘Safe Sleep Policy’, where babies and children will be placed on their backs to sleep. If you would like your child to go to sleep in any other position, please sign to consent (Medical waiver signed by Doctor required for babies 6 months of age and under). I agree I disagree Confirmation * I accept that the information above is correct and that I agree to give one calendar months notice to change registered hours or terminate my contract, or to pay fess in lieu thereof. I agree I disagree Thank you!
