1
Off Rodwell Avenue, Weymouth, Dorset. DT4 8SG
Telephone (01305 788270)
Registered Charity No: 272865
OFSTED No 141003
rodwellsch@btinternet.com
CHILD’S REGISTRATION AND RECORDS
Your Child’s Details
Child’s Full Name:
Name By Which Child Is Known:
Child’s Home Address:
Postcode:
Telephone Number:
Child’s Date Of Birth:
email:
Mobile:
Male/Female:
Your Details
Adults living at home with child:
Legal relationship to child:
Full name:
Mr/Mrs/Miss/Ms -------------------------------------------------------------------------------------------------Mr/Mrs/Miss/Ms------------------------------------------------------------------------------------------------Is there anyone else who has parental responsibility but does not live with the child?
Full name:
Legal relationship to child:
-Mr/Mrs/Miss/Ms--------------------------------------------------------------------------------------------------Address---------------------------------------------------------------------------------------------------------------Postcode:-------------------------------------------------Telephone:
Is your child subject to any Court Orders?
Yes/No --------If yes, please give details ------------------------------------------------------------------------Daytime Emergency Contacts(local only) Please keep informed of any changes
Name: -----------------------------------------------Relationship: ----------------------------------------------------Home telephone:----------------------------------Work telephone:------------------------------------------------Address:-------------------------------------------------------------------------------------------------------------------Notes: -------------------------------------------------------------------------------------------------------------------Name: -----------------------------------------------Relationship: ----------------------------------------------------Home telephone:----------------------------------Work telephone:------------------------------------------------Address:-------------------------------------------------------------------------------------------------------------------Notes: -------------------------------------------------------------------------------------------------------------------- Name: -----------------------------------------------Relationship: ----------------------------------------------------Home telephone:----------------------------------Work telephone:------------------------------------------------Address:-------------------------------------------------------------------------------------------------------------------Notes: -------------------------------------------------------------------------------------------------------------------Who Will Normally Collect Your Child:
Password:
Documents/New Starter/Enrolment Form V1.2
Health Details
Doctor’s name:---------------------------------------Health Visitor Name:------------------------------------------Surgery:
-----------------------------------------------------------------------------------------------------------Telephone Number:----------------------------------Child’s NHS number ------------------------------------------please
give details of medical conditions, allergies, regular medication etc
Please state if there is any reason why your child may not take part in food preparation/tasting in
School i.e. food allergy
Is your child receiving help from Speech Therapist/Health Visitor/Behaviour Support/ Social services / or
disabilities etc?
Yes/No --------If yes, please give details ----------------------------------------------------------------------
Records Of Any Accidents Or Absences Through Infectious Diseases
Is Your Child Dry During The Day?
Yes
Will Your Child Drink Milk?
No
Immunisation Record
Polio
Yes
(Please tick)
MMR
No
Triple
Is Your Child Right Or Left Handed
HIB
Right
Left
General Details
What are your preferred days for your child to attend (please tick boxes below):
MON
AM
TUES
PM
AM
WEDS
PM
AM
THURS
AM
PM
PM
FRI
AM
Lunch club is optional, however if you know which days you would like your child to attend please tick the
relevant boxes below:
MON
TUES
WEDS
THURS
FRI
To help us to get to know your child and help him/her settle in to Pre-School quickly, is your child:
Shy
Reserved
Outgoing
Which school will your child attend?
Mixes well with other children
Mixes well with adults
Have you registered your child with a school?
What is your religious denomination?
Is there anything not covered above that you feel we need to know about your child:
Documents/New Starter/Enrolment Form V1.2
The Pre-School takes children throughout the year from the age of 2 years. There may be a waiting
list on occasion so please try and register your interest as soon as possible. The Pre-School is run on
the same term timetable as local schools.
If there are any issues in this registration form that you are unsure about please feel free to speak to
the supervisor/ deputy privately. All information will be treated in confidence
PERMISSION.
YES
NO
I give permission for outings (shops, library, walks etc.) with adults at Pre-School
with a ratio of 1 adult to 2 children. I know of no medical or other reason why he /
she should not participate.
I give permission for sun cream to be applied to my child in summer when
required.
I give permission for my child to be photographed whilst participating in PreSchool activities.
I give permission for my child to be filmed by video camera whilst participating in
pre- school activities.
I give permission for my child to be observed in play and activities during their
time at Pre-School in accordance with Ofsted regulations.
CONTRACT: If you wish to remove your child from Pre-School a 3 weeks notice (in writing) or 3
weeks fees in lieu of Notice are required. If your child is not funded, fees are required even if your
child is sick or on holiday.
I have read and fully understand the policies and details supplied by Pre-School.
Parents/Guardians Signature: ................................................................................
Print: ......................................................................................................................
Date: ......................................................................................................................
Documents/New Starter/Enrolment Form V1.2
PARENTAL CONSENT FORM
Your child's name:
......................................................................................................
Date of birth and age:
......................................................................................................
Name of parent/guardian:
(BLOCK CAPITALS PLEASE)
......................................................................................................
Address:
......................................................................................................
......................................................................................................
......................................................................................................
Postcode:
......................................................................................................
e-mail:
......................................................................................................
Telephone Numbers:
Home: .........................................................
Work: .....................................................
Mobile: ............................................................................
As the parent/guardian of the above child I consent to any emergency medical treatment necessary during the
running of Rodwell Pre-School.
I therefore authorise the Manager or Deputy to sign on my behalf, any written form of consent required by
hospital authorities, should the delay required to obtain my signature be considered by medical staff to be
likely to endanger my child's health and safety. On the understanding, that every effort shall be made to
contact me. (Please note it is very important to keep the Pre-School informed of any changes in contact
numbers)
Signed parent/guardian:
......................................................................................................
Print:
......................................................................................................
Date:
......................................................................................................
Signed Manager /Deputy:
......................................................................................................
Print:
......................................................................................................
Date:
......................................................................................................
Documents/New Starter/Enrolment Form V1.2