Stickleberries Registration Form

Child's Information: *

First Name Middle Name Last Name

Gender *

Name to be called:

Nickname or abbreviation

Date of Birth: *

Date Date Picker Icon

When would you like your child to start at Stickleberries?

Primary Carer 1

Title First Name Last Name

Relationship to Child:

Home Phone No:

Work Phone No:

Mobile No:

Email:

example@example.com

Date of Birth:

Date Date Picker Icon

Address

House No or Name
Street Address
Town	County
Postcode	Country

Do you have Parental Responsibility? (If only one parent/guardian has been given responsibility then proof will be necessary.) *

Yes No

Primary Carer 2

Title First Name Last Name

Relationship to Child:

Home Phone No:

Work Phone No:

Mobile No:

Email:

example@example.com

Date of Birth:

Date Date Picker Icon

Address

House No or Name
Street Address
Town	County
Postcode	Country

Do you have Parental Responsibility? *

Yes No

Collection:

Name of person collecting from Stickleberries if different from above. Children will only be allowed to leave with a named person.

Emergency Contact 1:

First Name Last Name

Telephone Number:

Mobile:

Relationship to child:

Emergency Contact 2:

First Name Last Name

Telephone Number:

Mobile:

Relationship to child:

How did you hear about Stickleberries?

Name and Address of Child's Doctor:

Have there been any medical complications, including complications at child birth? If Yes please say what these were. i.e. premature

Does your child have any known medical conditions? (Please describe)

Does your child have any known allergies or major dislikes or dietary requirements? (e.g. food, materials etc)

Any additional information:

I give consent for the details entered on this form to be used and stored on the Nursery’s secure online booking system (Parenta) and for my email address and date of birth to be used to set up a parent portal for invoicing and updating my child’s details.

Yes No

I give consent for a secure online learning journey to be created for my child using Tapestry, where observations, reports, photographs etc will be stored. I also give consent for my provided email address to be used for parental access to be set up.

Yes No

Some of the routine activities may involve supervised short walks for which you must give your permission. I agree to my child taking supervised walks in the local area

Yes No

I consent to any emergency medical treatment necessary whilst my child is attending Stickleberries. I authorise the staff to sign any written form of consent required by hospital authorities if the delay in getting my signature is considered by the doctor to endanger my child’s health or safety.

Yes No

I consent to photographs being taken of my child, to be used as evidence of learning and progression and that these photographs will be used strictly for these purposes only and kept on the premises at Stickleberries. I am aware that some photos may have images of other children in them.

Yes No

I give permission for my child’s records to be passed to a receiving setting/school and to be made available to other caring professionals.

Yes No

I give consent for you to apply factor 30+ on hot sunny days, if I have not provided my own.

Yes No

I give consent for Stickleberries to use Sudocrem or similar products to help prevent nappy rash.

Yes No

I give consent for my child to be able to go to Capers Nursery (our sister setting) in insured transport provided.

Yes No

I give consent for Stickleberries to drop off and/or pick up from school using insured transport.

Yes No

In the event your child experiences anaphylaxis, the law allows us to administer the epi-pen of another child (if available), to save their life. Do you consent for us to do this in an emergency?

Yes No

I consent to images of my child being used on the company’s website and for promotional purposes.

Yes No

I understand that Stickleberries cannot accept responsibility for children’s possessions or valuables whilst they are attending the sessions.

Yes No

Signature

Clear

Print Name

First Name Last Name

Date

Date Date Picker Icon

I attach a copy of my child’s birth certificate to be kept on file.

Upload File

Parental Agreements

Partnership between the childcare provider and staff working with parents and carers to meet the needs of the children, both individually and as a group.

Information given to parents:

o Stickleberries is open from 07.45 – 18.00 to children between the ages of 0 -11 and has various policies available for inspection by parents.

o Stickleberries will pass information to parents via the parents’ notice board, letters home and verbal communication, on a regular basis and prompt action will be taken if any concerns are raised.

o Staff details and information about activities are available on request.

o All fees will be paid on or before the date provided. Should fees remain unpaid for 4 weeks, after the final date, Stickleberries will ask for full payment and the child may be excluded from the group until payment is received. In cases of hardship parents are advised to discuss the situation in confidence with the supervisor.

If you wish to remove your child from Stickleberries then you must inform us in writing 4 weeks prior to your child leaving.

o All parents/carers of children using Stickleberries are requested to be supportive to the supervisor.

o Children should be collected promptly at the end of the session.

o Children are not allowed to leave the premises unless accompanied by their parents/guardian or nominated adult.

o If a parent/guardian is unable to collect his/her child/ren, they must inform the supervisor of the nominated other responsible adult. No child will be allowed to leave the premises with person or persons unknown.

o Any problems, which cannot be satisfactorily resolved between parents and staff, may be referred to the management, in line with Stickleberries complaint procedure.

o All staff are aware of the need to maintain confidentiality about matters concerning families and children.

o Records will be kept containing details about the child, including relevant health, religion and diet information, parents and/or emergency contact details, child protection records if applicable and any appropriate signed consent forms. Parents have access to all written records about their child/ren.

IMPORTANT NOTICE – GENERAL DATA PROTECTION REGULATION (GDPR)

In compliance with GDPR, any information you provide here will be kept secure and treated confidentially. The data collected will only be used by Stickleberries and will not be disclosed to any external sources without your prior consent unless required to do so by law.

I / we have read the parental partnership agreement and acknowledge the information.

Signature

Clear

Print Name:

First Name Last Name

Date

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