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FOR NURSERY & PLAYCLUB USE ONLY
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Catergory: Pre-School ¨ Robins ¨ Canaries ¨ Owls ¨ Playclub ¨
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Deposit Status:
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Date of Enrolment:
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Starting Date:
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Child’s Date of
Birth:
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Child’s Sex: Male ¨ Female ¨
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Names of Brothers/Sisters:
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Person who will
collect Child:
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Ethnic Origin
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Preferred Language
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Religion
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Black ¨ African
¨ Afro-Caribean
¨ South Asian
¨ U.K.
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¨ English
¨ Punjabi
¨ Gujarati
¨ Bengali
¨ Urdu
¨ Cantonese
¨ Vietnamese
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¨ C of E
¨ Catholic
¨ Other Christian
¨ Hindu
¨ Rastafarian
¨ Sikh
¨ Jewish
¨ Bhuddist
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White ¨ U.K.
¨ Irish
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Other:
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Other:
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Other:
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Are there any
issues relating to your child’s culture, religion, language
or race that we should aware of whilst providing care for
your child?
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Special Dietry
Requirements:
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Mother’s Full Name:
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Mother’s Home
Address:
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Postcode:
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Mother’s Home
Telephone no:
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Mother’s Employer:
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Mother’s Work
Telephone/Mobile no:
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If not Mother
but Guardian tick here ¨ If Child’s Home address
tick here ¨
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NB The account
will be sent to the Mother/Guardian unless otherwise stated.
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Father’s Full Name:
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Father’s Home
Address (if different from Mother’s):
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Postcode:
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Father’s Home
Telephone no. (if different from Mother’s):
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Father’s Employer:
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Father’s Work
Telephone/Mobile:
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Any Special Needs, allergies, or health considerations?:
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Anything else the nursery should know about your child?:
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Immunisation/Vacinations:
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Date Given
Date Given
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Diphtheria
Polio
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Whooping Cough Measles
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Tetanus MMR
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Child’s Doctor:
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Doctor’s Address:
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Postcode:
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Doctor’s Telephone
No:
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Should any urgent
matters of concern arise, I give permission for my child to
be given emergency treatment as necessary and/or contact to
be made with the appropriate medical/health/social service
authories.
Yes or No:
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I give permission
for my child to go on walks and outings from the nursery/playclub
providing he or she is accompanied by appropriate staff.
Yes or No:
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I give permission
for my child’s photograph and artwork to be published on the
Mews web site or used in other forms of Mews advertsing.
Yes or No:
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Signed: ____________________________ Date: ___________________
Print this form by downloading either a Microsoft Word document
or Acrobat Reader file. Right Click>Save Target the appropriate
icon below:
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Word file (.doc) for Windows platform. |
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Portable Document Format (.pdf)
for Macintosh platform. |
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