Registration Form

Plantpots Jesmond Registration Form
Please tick as required.
What sessions would you like your child to attend? *

Monday am Monday pm Tuesday am Tuesday pm Wednesday am Wednesday pm Thursday am Thursday pm Friday am Friday pm
Name of Child *

First Name Last Name
Preferred Name *
Date of Birth *
Name parent 1 *
Name parent 2 *
E-mail *
example@example.com
Address *

Street Address

Street Address Line 2

City

Postal / Zip Code
Phone Number *

Area Code Phone Number
Additional Phone Number

Area Code Phone Number
Who has Parental Responsibility for this Child? (Please provide names and relationship to child) *
EMERGENCY CONTACT (Please provide 2 emergency contact names, contact numbers and relationships to the child) *
OTHER PEOPLE AUTHORISED TO PICK UP YOUR CHILD (Please supply a name, address and password for each person)
WHAT IS THE DESIRED START DATE FOR YOUR CHILD? *
How did you hear about Plantpots Jesmond?
What made you choose Plantpots Jesmond?
*Please note that due to the popularity of our preschool, places are not always available. When no places are available applicants will go on a waiting list and places will be offered in order of when the application was submitted.
Date Form Completed *
Name of person filling out the form *
Relationship to Child *
Contact Number *
Who lives with the child? (Please provide name, age, gender and relationship to child for each person) *
ABOUT YOUR CHILD
Special Interests and Activities
Ethnicity *

White British White/Irish White/Other Caribbean African Indian Pakistani Bangladeshi White/Black Caribbean White/Black African White & Asian Other mixed Chinese Other Ethnic Group Traveller (Irish Heritage) Option 16
Please state if any additional languages to English are spoken at home and if so what is the child's first language
Is your child disabled? *

Yes No
Speech Difficulties *

Yes No
Hearing/Vision Difficulties *

Yes No
Physical Problems
Allergies/Dietary Requirements
Are your child's preschool injections up-to-date?

Yes No
Please tell us anything else you think might help us know your child better and help them to have a positive learning and growing experience with us by filling in the questions below:
Child's Siblings (this will help us spell their names on written/artwork)
Family Pets
What are your child's favourite snack foods?
What are your child's dislikes?
Any other information you would like us to know?
PERMISSION AND CONSENT
Name of Child *

First Name Last Name
I give permission for this child's photograph to be taken for use in learning journals, on displays for Plantpots and in record books. *

Yes No
I give consent for my child to have their face painted if they wish when these activities are arranged *

Yes No
I give consent to my child's work being displayed *

Yes No
I give consent for my child being videoed *

Yes No
I give consent for my child's work being labelled with their name *

Yes No
I give consent for my child being transported to hospital in an emergency *

Yes No
I give consent for my child receiving emergency treatment at hospital *

Yes No
I give consent for basic First Aid to be carried out by a trained First Aider if necessary. This includes the use of plasters and alcohol-free antiseptic wipes if necessary *

Yes No
I give permission for this child to be taken on local visits where no transport is required, for example a trip to the local shops or library. *

Yes No
Date
Sun Cream Consent Form
Name of Child *

First Name Last Name
I give consent for the setting staff to apply the following make of sun cream which I have provided. This cream has been used previously on my child and does not trigger an allergic reaction and the bottle is suitably labelled with my child's name. It should be applied as specified below:
Sun Cream *
The Factor of the cream is... *
The sun cream is to be applied once a day before the first outdoor play session

Tick if applicable
The sun cream is to be applied before every outdoor play session

Tick if applicable
Please tick the statement that applies to you: *

I give permission for staff members to apply the above sun cream to my child. I understand that, having ticked this statement, should I not provide the sun cream named above, my child may have to remain indoors in hot weather. I will be responsible for the application of sun cream during hot weather and I give permission for my child to play outdoors without further sun cream application by the childcare setting staff.
Date *
PARENT CONTRACT
Name of Parent *
Name of Child *
Date of Birth *
Nursery Start Date *
Monthly Payment
Attendance *

Monday am Monday pm Tuesday am Tuesday pm Wednesday am Wednesday pm Thursday am Thursday pm Friday am Friday pm
Fees:
1. Fees are £30 for a half day (8am-1pm/1pm-6pm), £60 for a full day (8am-6pm) and must be paid within 10 working days of the start of term for the half term period your child will be attending. A late payment charge of £10 per day will be added to your next invoice if the 10 days are exceeded. An annual administration fee of £50 is also required to cover the yearly administration costs and assessments for your child.
2. Fees are payable during periods of absence from the Preschool, including sickness and any holidays taken when the Preschool is open. Attendance may not be re-allocated in lieu of sickness or any other reason that your child does not attend the Preschool.
3. This rule is necessary so that the Preschool can properly budget for its own outgoings, which continue whether or not all children are present. If the Preschool has to be closed due to any reason beyond the control of the Preschool, such as power failure or adverse weather conditions, no compensation will be paid or refund given.
4. If extra sessions are booked, they must be paid for by cash/cheque directly to the Preschool Manager on or before the date of the extra session.
5. If you wish to cancel your child’s place, one month’s notice must be given to the Preschool Manager. Payments will be due in lieu of notice if your child is withdrawn without giving notice or you do not use your child’s place after notice has been given.
6. If payments fall into arrears your place may be withdrawn/or we may exercise our statutory right to claim interest and compensation for debt recovery costs under the late payment legislation [Late Payment of Commercial Debts (Interest) Act 1998].
7. Preschool morning sessions end at 1pm and afternoon/full day sessions end at 6pm. Children must be collected at the end of their session. If your child is persistently picked up late, an additional fee will be charged.
8. All fees are subject to change at the Proprietor’s discretion.
9. The offer of a place and its acceptance by parents gives rise to a legally binding contract on the terms of these Terms and Conditions and the Policies and Procedures of the Preschool. Any queries about them should be raised with the Preschool Manager.
Parent Declaration: *

I agree to abide by the above Terms and Conditions
Date: *
EMERGENCY MEDICATION SHEET
We are required to have written authority from a parent/guardian for the administration of all medication during the Plantpots day.

It is the parent's/guardian's responsibility to inform staff if their child has had medication administered prior to arriving at Plantpots.

CALPOL PARACETAMOL SUSPENSION will only be administered after we have tried to reduce the child's temperature naturally i.e tepid sponge or by removing clothing. This will be provided by Plantpots.

We cannot administer any emergency medication without your consent via this form.

Dosage will depend on your child's age and instructions on the medication bottle.

Management will notify the parent where possible, prior to administering the medication.
Name of Child *

First Name Last Name
Date of Birth *
Parent Authorisation *

I authorise Plantpots to administer Calpol Paracetamol Suspension to my child
Date *
Parent Declaration (Early Years and Free School Meal Funding)
Please fill in the Parent Declaration form and return to us so you can claim your free school hours.

The form can be found here
By submitting this form you are confirming that all details are correct and that you have given/not given your permission/consent where indicated.

Data Protection: The information given to Plantpots in this document will be used only by us for the purpose of registering your child's place and communicating with you once your child is a member of the nursery. This includes sending you a termly email newsletter to share with you important news and events, and twice-yearly questionnaires to gain valuable feedback on our service.

We will never share your information with a third party.

For full details of how we safeguard your personal information, see our Privacy Policy.
I agree with Plantpots Privacy Policy
Should be Empty:

Plantpots Jesmond Registration Form

ABOUT YOUR CHILD

PERMISSION AND CONSENT

Sun Cream Consent Form

PARENT CONTRACT

EMERGENCY MEDICATION SHEET

Parent Declaration (Early Years and Free School Meal Funding)