Registration Form
Name of child...........................................................................................Date of birth...............................................
Address.............................................................................................................................................................................
.............................................................................................................................................................................................
Parents/Guardians name/s and Telephone No........................................................................................................................................................................................
Other Contact No...........................................................................................................................................................
Who has parental responsibility ?..............................................................................................................................
Who is authorised to pick up your child ? …............................................................................................................
Any other Contact names or numbers in the event of us being unable to contact any of the above ?
….........................................................................................................................................................................................
Name, Address and Tel No of Doctor ...................................................................................................................
…........................................................................................................................................................................................
Immunisation Details .................................................................................................................................................
Special needs:
Dietary……………………………..........................................................................................................…..........................
Medical……………………………………………………………………………………………................................
Allergies ……….…..................…………………………………………………………………….................................
Language spoken at home................................................................................................................................………….
Religion/Belief………………………………………………………………………………………............................
I, the parent/guardian of the child named above give my permission for the child to attend hospital with a member of Playday’s staff in an emergency at the playgroup leader’s discretion.
I confirm that I have read and understood the preschool policies and procedures.
Parent/Guardian’s signature..............................................................................................Date..................................................................
Any other information or concerns (Please use other side if required) ....................................................…………………….................................................................................................................
claire.lakin1@btopenworld.com / 07595 603498
Staff Use - Birth Certificate Confirmed Start Date :
Name of child...........................................................................................Date of birth...............................................
Address.............................................................................................................................................................................
.............................................................................................................................................................................................
Parents/Guardians name/s and Telephone No........................................................................................................................................................................................
Other Contact No...........................................................................................................................................................
Who has parental responsibility ?..............................................................................................................................
Who is authorised to pick up your child ? …............................................................................................................
Any other Contact names or numbers in the event of us being unable to contact any of the above ?
….........................................................................................................................................................................................
Name, Address and Tel No of Doctor ...................................................................................................................
…........................................................................................................................................................................................
Immunisation Details .................................................................................................................................................
Special needs:
Dietary……………………………..........................................................................................................…..........................
Medical……………………………………………………………………………………………................................
Allergies ……….…..................…………………………………………………………………….................................
Language spoken at home................................................................................................................................………….
Religion/Belief………………………………………………………………………………………............................
I, the parent/guardian of the child named above give my permission for the child to attend hospital with a member of Playday’s staff in an emergency at the playgroup leader’s discretion.
I confirm that I have read and understood the preschool policies and procedures.
Parent/Guardian’s signature..............................................................................................Date..................................................................
Any other information or concerns (Please use other side if required) ....................................................…………………….................................................................................................................
claire.lakin1@btopenworld.com / 07595 603498
Staff Use - Birth Certificate Confirmed Start Date :
