Registration

Section 1: Family Details

Child's full name *

Preferred or familiar name

Date of birth *

Birth Certificate presented?

Yes

No

Parents / Carers Names

Parent/carer addresses

Child's usual address *

Other people allowed to collect your child? (Must be over 16 years of age)

Yes

No

Section 2: Contact Details

Telephone Home

Mum Work

Dad Work

Mobile (Mum)

Mobile (Dad)

Email address (for invoice) *

Password (for collection and invoice retrieval) *

Who has Parental Responsibility for your child?

Who has Legal Contact with your child?

Section 3: Daytime Emergency Contact Details

Mother

Father

1st alternative contact (required)

2nd alternative contact (required)

Section 4: Medical Information

Doctor's name, address and telephone no:

Health Visitor's Name and telephone no:

Does your child have any special health requirements?

Any known allergies? (e.g., food, animals, plasters, medication, etc.)

Does your child have any special dietary requirements, preferences or food allergies?

Are all childhood vaccinations up to date?

Yes

No

Partial

Section 5: Consent Information

Please check the boxes to give your consent for:

Outings

Holding personal information (paper and computer based)

Sharing information with other professionals (e.g., Health Visitor or Speech therapist)

Photography to be used in-house only (e.g., photo observations for child's folder)

Photography to be used in publicity material, including on the internet (children's names will NOT be used)

First aid and emergency medical treatment, including the administration of Calpol for temperature above 39℃

Use of child's own provided sun cream or a named brand supplied by the nursery

Use of plasters

Section 6: Other Information

Other languages used at home:

Ethnic origins:

Festivals celebrated at home:

Details of any other settings or childcare attended:

Details of any other agencies or professionals working with your child and their role:

Any other details or information it may be useful for us to know?

Section 7: Childcare Requirements

Required Start date?

Please mark the days and any extra services you require:

Saturday (12.00pm to 4.00pm)

Sunday (12.00pm to 4.00pm)

Any Extra Services (State Here):

How did you hear about us?

Magazine

Children's Info Service

NHS Staff Info

Flyer

Website

Recommendation

Sign outside

Other

Did you look at any other Provider?

Why did you choose Jonosheba Daycare?

Section 8: Terms and Conditions

Please read carefully before signing:

Admission

A completed Agreement Form and Registration fee and deposit are required to secure your child's place.

Registration Fee and Deposit

The registration fee of £30 covers administration and settling sessions. A deposit of two weeks fees is required at time of booking. The deposit will be refunded by the 20th day of the following month of your child's leaving date, providing a minimum period of three months attendance and appropriate notice has been given.

Fees and Invoices

Accounts are payable weekly, for a calendar month of childcare. Accounts are payable by standing order, card or cheque made payable to "Jonosheba Daycare". We also accept childcare vouchers. We can apply on your behalf for the Free Entitlement from your local LEA.

Opening Times

The center sessions run from 12:00 to 17:00 on Saturdays and Sundays. The center is open all year except bank holidays, Christmas & New Year closure and occasional inset days.

Termination, Cancellation and Change of Sessions

One month notice is required by either party for any change of sessions or termination of agreement. If parents choose to leave prior to the end of their notice, fees are non-refundable.

Accidents and Illness

The center reserves the right to administer first aid and any emergency treatment as required. Parents will be informed of all accidents and will be asked to sign an Accident record form.

Full Terms and Conditions are available in the complete document.

I have read and understand the complete Terms and Conditions and agree to be bound by them

Section 9: Agreement and Signature

Parent's/Carer's Signature

Sign using your mouse or finger on touch screen

Printed Name

Date

Important: We ask that you keep us informed of any changes to your details. Periodically we may ask you to confirm your details for our records.

Registration and Agreement Form