Registration

Use the Registration form below to send us as much details about your child and yourself.

Please also read the ‘Nursery Terms and Conditions’: Terms and Conditions

Child Details

Childs First Name *e.g. John
Childs Last Name *e.g. Smith
Childs Date of Birth *should be written as such DD/MM/YYYY
Childs Religion *
Childs Nationality *
Childs First Language *
Childs Address *
please include postal code e.g. AB11 6EL
Days Required & Start Date
e.g. Monday, Wednesday, Friday from 6th March 2017

Parent/Carer Details (1)

Parent/Carer First Name *e.g. John
Parent/Carer Last Name *e.g. Smith
Parent/Carer Home Number *
Parent/Carer Mobile Number
Parent/Carer Work Number
Parent/Carer Business Address
Parent/Carer Email Address *

Parent/Carer Details (2)

Parent/Carer First Name (2)
Parent/Carer Last Name (2)
Parent/Carer Home Number (2)
Parent/Carer Mobile Number (2)
Parent/Carer Work Number (2)
Parent/Carer Business Address (2)
Parent/Carer Email Address (2)

Specific Dietary Needs/Food or Drink Allergies

Instructions Are there any foods/drinks that your child may not have for the following reasons i.e. religious, allergy, medical or other, e.g. vegetarian, non-dairy, diabetic
If yes, please specify

Medical/Illnesses

Any serious illness/condition? If yes, please specify
Symptoms/Medication/Treatment required with regard to illness/condition
Any skin allergies/conditions? If yes, please specify
Symptoms/Medication/Treatment required with regard to skin allergies/conditions
Any medication allergies? If yes, please specify
Any special education needs/disabilities? e.g. speech therapy, occupational therapy. If yes, please specify
Immunisations - Is your child up to date with these?
YesNo
Please provide details of those received
Has your child had any childhood infectious disease e.g. Chicken Pox. If yes, please specify

External Contacts

G.P Name Local General Practioner
G.P Telephone Number include std e.g. 01224 211262
Health Visitor
Health Visitor's Number include std e.g. 01224 211262
Dentist
Dentist's Number include std e.g. 01224 211262

Emergency Contacts - Details of two alternative people who we may contact in an emergency, should we be unable to contact you

Full name including title e.g. Mr John Smith
Home/work telephone no including STD code e.g. 01224 211262
Relationship to child
Mobile number
Full name including title e.g. Mrs Mary Jones
Relationship to child
Mobile number
Home/work telephone no including STD code e.g. 01224 211262

Parent/Carer Declaration – In registering my child, at Little Dreams Nursery, I have read, understood and agree to abide by all the Terms & Conditions (June 2016) laid down by the Nursery.

Parent/Carer (1) first name, second name e.g. John Smith
Date (1) should be written as such DD/MM/YYYY
Parent/Carer (2) first name, second name e.g. Mary Jones
Date (2) should be written as such DD/MM/YYYY
Data Protection In compliance with current UK Data Protection legislation, any information you provide to us will be kept secure and treated confidentially and will not be disclosed to any external sources without your prior consent.
I agree to the Terms and Conditions of Little Dreams Nursery
YesNo

Verification

Please enter any two digits with no spaces (Example: 12)*
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