Registration

Fields marked with an * are required.

Child's Details

First Name *

Middle Name

Surname *

Date of Birth *

Gender *

Male Female

Religion *

Nationality *

Ethnicity

Child's Home Address

House Name/Number *

Street *

Town/City *

Post Code *

Parent/Guardian Details (Parent 1)

First Name *

Middle Name

Surname *

Relationship To Child *

Do you have parental responsibility? *

Yes No

Date of Birth *

Email *

Contact Phone (Home)

Mobile *

Work

Family email (For invoices) *

Address (If Different From Child's)

Post Code

Place of Work *

Occupation

National Insurance Number *

Parent/Guardian Details (Parent 2)

First Name *

Middle Name

Surname *

Relationship To Child *

Do you have parental responsibility? *

Yes No

Date of Birth *

Email *

Contact Phone (Home)

Mobile *

Work

Address (If Different From Child's)

Post Code

Place of Work *

Occupation

National Insurance Number *

Additional Information

Other Contact(s) With Parental Responsibility

Please list contacts with their full name, address, contact number and relationship to child:

Emergency & Household

Other Emergency contact(s) - Please add 3 emergency Contacts *

List their full name, address, contact number and relationship to child:

People Authorized To Pick Your Child *

List below, names and relationship of people authorized to pick up your child:

List People Living In Same Household

List below, names and relationship of any other people living in the same household (if applicable):

Further Details

What Languages Are Spoken At Home? *

Child's Position In Family *

List Details of Other Siblings Living At Home

List Name(s), Date of Birth, School Attended:

Any Other Additional Information?

Choose a password for use by anyone collecting your child *

Preferences & Funding

Preferred Start Date *

Preferred Session *

Morning (8am-1pm) Afternoon (1pm-6pm) Full Day (8am-6pm) Additional Hours

Specify Additional Hours

Preferred Days? *

Monday Tuesday Wednesday Thursday Friday

Funding Eligibility *

15 Hours Free Entitlement 30 Hours Free Entitlement Other Funding Sources None

Child Development Information

Has your child attended a nursery before? *

Yes No

If yes, please specify:

Does your child have any special educational needs or disabilities? *

Yes No

If yes, please specify:

Kindly state any additional support required

Medical & Health Information

Doctor's Full Name

Health Visitor's Name

Health Visitor's Phone

Immunized Against *

Polio Diphtheria Tetanus Cough MMR

Immunisations up to date? *

Yes No

Any ongoing medical conditions? *

Yes No

If Yes, Please State:

Any special health considerations? *

Yes No

Any allergies or special dietary requirements? *

Yes No

If yes, please specify:

Any medications required during nursery hours? *

Yes No

If yes, please provide details:

Any ongoing administration of prescribed medication required? *

Yes No

If Yes, Please Give Details Below:

Dietry Restrictions *

Parental Agreements & Permissions

I agree to provide necessary emergency contact information *

Yes No

I acknowledge and understand the nursery's policies and procedures *

Yes No

I consent to my child's participation in nursery activities *

Yes No

Permission for Photographs / Videos (Internal) *

Photographs and videos of your child are taken routinely for display purposes within the nursery and to record observations of your child to enable us to assess his/her development. These are shared with carers via the secure nursery management system.

Yes No

Permission for Photographs / Videos (social media) *

I give my permission for static and/or moving images to be used for: Living Heritage Nursery/Facebook/Instagram page/Social media platforms

Yes No

Permission for Photographs (Photographer) *

I give my permission for photographs to be taken of my child from time to time by an approved photographer for my consideration to purchase copies. All copies not purchased will be destroyed.

Yes No

Permission for Local Outings *

I give permission for my child to be taken on supervised visits, e.g. to local shops, local parks, or to post a letter.

Yes No

Permission for use of normal baby/childcare products *

I give my consent to staff at Living Heritage Nursery to use all normal baby/child care products, including washing products, cotton wool, and sun cream.

Yes No

Please list any products you do not wish us to use on your child:

Permission for sharing child's details with schools *

I give my consent to Living Heritage Nursery to share my child's development details with the school that he/she will be moving to from a LHN setting, in support of transition.

Yes No

I have read and agree with the privacy notice *

I have read and agree to the nursery's terms and conditions. *

Submission

By clicking submit, I confirm that the information provided is accurate and complete. I give my permission for all stated above. I agree to abide by the policies and procedures of Living Heritage Nursery. *