Registration Form

Registration Form
PLEASE NOTE: Only one child’s details are to be entered on this form.
Child's full name*

First NameLast Name
Date of birth*

DayMonthYear
Date
Current Date

DayMonthYear
Date
Age of child (Days)
Age of child (Months)
Age of child (Years)
Gender*

BoyGirl
Child's Religion*
Child's Ethnicity*
Child's Home Address*

Street Address

Street Address Line 2

CityState / Province

Postcode
Parent/Carer 1: Please select Title*

MrsMsMissMr
Parent/Carer 1:*

First NameLast Name
Relationship to Child*
Tel No*

Area CodePhone Number
Mobile No*

Area CodePhone Number
Work No*

Area CodePhone Number
Email*
example@example.com
Parent/Carer 2: Please select Title*

MrsMsMissMr
Parent/Carer 2:*

First NameLast Name
Relationship to Child*
Tel No*

Area CodePhone Number
Mobile No*

Area CodePhone Number
Work No*

Area CodePhone Number
Email*
example@example.com
Legal Guardian: Please select Title

MrsMsMissMr
Legal Guardian:

First NameLast Name
Relationship to Child
Tel No

Area CodePhone Number
Mobile No

Area CodePhone Number
Work No

Area CodePhone Number
Email
example@example.com
Emergency Contacts
Emergency Contact 1: Please select Title*

MrsMsMissMr
Name of Emergency Contact 1*

First NameLast Name
Relationship to Child*
Tel No*

Area CodePhone Number
Mobile No*

Area CodePhone Number
Emergency Contact 2: Please select Title*

MrsMsMissMr
Name of Emergency Contact 2*

First NameLast Name
Relationship to Child*
Tel No*

Area CodePhone Number
Mobile No*

Area CodePhone Number
Child's Doctor: Please select Title*

MrsMsMissMr
Name of Child's Doctor*

First NameLast Name
Tel No*

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postcode
Sessions
Child's full name*

First NameLast Name

Please tick the preferred sessions you will require for your child*

Rows	Monday	Tuesday	Wednesday	Thursday	Friday
Full Day 7:30am - 6:30pm
Morning 7:30am - 1:00pm
Afternoon 1:00pm - 6:30pm
Short Day 9:00am - 3:00pm
Short Day 8:00am - 4:00pm

Please tick if you require a term time only place
PLEASE NOTE: The dates you have picked are subject to availability and confirmation from Phoenix Day Nursery
Preferred start date of Session*

DayMonthYear
Date
Password*
Please remember your password and keep it confidential
Parent/Carer 1 signature*
Date*

DayMonthYear
Date
Parent/Carer 2 signature*
Date*

DayMonthYear
Date
THIS APPLICATION IS PROVISIONAL AND NOT GUARANTEED UNTIL DEPOSIT
IS PAID AND CONFIRMATION GIVEN
To help us please tell us how you heard about us?
Outing Consent
As part of our weekly routine we take children out of nursery for exciting activities. We regularly visit the local parks, library and the local woods. Occasionally we may take children on outings to the local children’s centre or pet shop.
For any trip that requires our mini bus we will seek your permission separately.
For our local trips we require your authorisation. Please sign below granting your permission.
Permission for Phoenix Staff to take my child out of the nursery/ out of school clubs.*

I DO give my permission for Phoenix Staff to take my child out of the setting to walk to and from school and as part of any local trips they have planned.I DO NOT give my permission
Name of Child*

First NameLast Name
Name of Parent/Carer*

First NameLast Name
Signature*
Date*

DayMonthYear
Date
Sun Cream and Plaster Consent
During the summer months we will be applying sun cream to your child(ren), this is to be provided by parents and carers; we request it to be no lower than a factor 30. Please sign below for a member of staff to apply your child’s sun cream.
Sun Cream Consent*

I give my permission to a member of staff to apply sun cream on my childI DO NOT give my permission to a member of staff to apply sun cream on my child
Name of Parent*

First NameLast Name
Signature*
Date*

DayMonthYear
Date
In the event of your child having a cut, graze or any other wound that may require a plaster please sign below if you wish to give your permission for a member of staff to apply one.
Plaster Consent*

I give my permission to a member of staff to apply plaster on my childI DO NOT give my permission to a member of staff to apply plaster on my child
Name of Parent*

First NameLast Name
Signature*
Date*

DayMonthYear
Date
Photo Consent
We sometimes take photographs of the children in the nursery while they are taking part in activities. Photographs are only ever taken with parent’s permission.
There are different reasons this may happen throughout your child’s time with us at nursery. Please indicate below if you are happy for your child to be part of these photographs.
Name of Child*

First NameLast Name
I give permission for Phoenix Day Nursery to take the following photographs of my child whilst at nursery, as indicated below:*

Photographs to go in my child's own profilePhotographs to go on display boards at the nurseryPhotographs to go on publications to show an event at the nursery or help publicise Phoenix Day Nursery such as the nursery websitePhotographs to go on our Facebook pagePhotographs of my child to be shared in other children's profilesI DO NOT give permission to take any photographs of my child
Medication Consent
To allow our staff to manage any accident or illness in accordance with our policies and procedures, please read the relevant policies and procedures and then sign the consent below:

I understand that in the event of an emergency allergic reaction Phoenix Day Nursery will act on my behalf until such a time as I can be present. I give consent for a member of staff to administer the recommended dose of antihistamine required in the event of an allergic reaction. I understand that every effort will be made to contact me if this occurs.
Name of Child*

First NameLast Name
Signature of Parent *
Date*

DayMonthYear
Date
Accident, Illness and Calpol Authority
To allow our staff to manage any accident or illnesses in accordance with our
policies and procedures, please read the relevant policies and then sign the
authorisations below:
Name of Child*

First NameLast Name
I understand that in the event of sickness, an accident or any form of emergency Phoenix Nursery will act on my behalf until such a time as I can be present. I understand that every effort will be made to contact me as soon as any injury or illness is identified.
Name of Parent*

First NameLast Name
Signature of Parent *
Date*

DayMonthYear
Date
In the event of my child having a high temperature, I consent my child being given Calpol in the nursery by a qualified member of staff, following the procedures of the setting. I understand I will be contacted on every occasion that my child has a high temperature and Calpol is necessary.
Name of Parent *

First NameLast Name
Signature*
Date*

DayMonthYear
Date
Allergies, Dietary or Medical Needs
Does your child have any dietary requirements that we need to cater for?*

YesNo
Please indicate your child's dietary requirements that we need to cater for:*
Does your child have any medical needs that we will need to know to provide high quality care?*

YesNo
Please inform us below of any medical needs your child may have:*
Does your child have any allergies?*

YesNo
Please indicate your child's allergies below:*
Data Protection

In accordance with the Data Protection Act of 1998 any information you provide toPhoenix day Nursery will be kept secure at all times and treated in confidence. The information will be used by Phoenix day Nursery and in any cases involving outside bodies needing access to this information the nursery will seek your permission before sharing information.Below are details of how we use and store your data.
Why we have your data and how we use it:

So we can contact you regarding your child during their time at Phoenix.So we can email you with updates or any changes that are happening.We input the data onto our abacus system so your child’s details are correct for our registers.We may have to use your data with outside agencies if there is a safeguarding concern and this is only for the welfare of the child. If Ofsted requires information about any child in our setting.
How we store your data:

We store all paper copies of your data in a locked filing cabinet that the managershave access to.We store data onto our abacus system so it’s easy to access.Once your child has left us, your data will be put in a file in the loft where it stays forup to 25 years.
Name (Parent/Carer) *

First NameLast Name
Signature*
Date*

DayMonthYear
Date
Before submitting this form please agree to the statements below
I hereby confirm that I agree with all the Terms and Conditions as outlined in this form*

I agree with Terms and Conditions outlined in this formI do not agree with Terms and Conditions outlined in this form
I declare that the information provided by me on the above form is true and correct to the best of my knowledge*

AgreeDo not agree
Unfortunately we unable to submit this form without your agreement to the Terms and Conditions
Should be Empty:

Registration Form

Emergency Contacts

Sessions

Outing Consent

Sun Cream and Plaster Consent

Photo Consent

Medication Consent

Accident, Illness and Calpol Authority

Allergies, Dietary or Medical Needs

Data Protection

Why we have your data and how we use it:

How we store your data:

Before submitting this form please agree to the statements below