King’s Stanley
Playgroup
Kings Stanley Playgroup, Marling Close, Kings Stanley, Stonehouse, GL10 3JA
Telephone: 07974 589536
Email: kingsstanleyplaygroup@mail.com
Childs first name(s)……………………………………………………………………
Surname……………………………………………………………………………….
Date of birth…………………………
Child’s home address………………………………………………………
………………………………………………………………………………
Post code……………………
Please insert a photograph of your child and indicate below what they enjoy doing
This is ……………………………………………………………………………………
I enjoy ……………………………………………………………………………………..
………………………………………………………………………………………………
Birth certificate seen? YES/NO
How did you hear about our setting? ....................................................................................
Parent Details
Mother
Father
Full name…………………………………..
Full name………………………………
Postal address (if different)
Postal address (if different)
…………………………………………….
…………………………………………..
…………………………………………….
…………………………………………..
…………………….Post code…………….
……………….Post code……………….
Date of birth……………………………..
Date of birth……………………………..
National Insurance no…………………………………….
Telephone numbers
National Insurance no…………………………………….
Telephone numbers
Home………………………………………
Home……………………………………
Work……………………………………….
Work…………………………………….
Mobile……………………………………...
Mobile…………………………………..
Email address……………………………....
Email address…………………………..
Ethnic Origin………………………………
Family Religion…………………………
Others with legal contact with you child
Name
Relationship
Other children in family that live with you
Name
Relationship
Age
Emergency contacts (Please give 4 other possible names)
Name
Relationship to
child
Address
Phone number
If anyone else is collecting your child from playgroup, it must be reported to the playgroup
and they will be asked for a password.
Password………………………………………………
Please indicate others who may collect your child in your absence.
Name
Telephone number
Name and address of family doctor………………………………………………………
…………………………………………………………………………………………….
Postcode……………………………..Telephone number…………………………………
In the event of an emergency and no contact can be made do we have your permission to call
an ambulance? Yes/No Please circle
Professionals involved with the child or family e.g. Health visitors, Social workers
(Please continue on a separate sheet if necessary)
Name………………………………………………………………………………………..
Professional capacity……………………………………………………………………….
Telephone number………………………………………………………………………….
Details of any allergies, medical conditions, (Asthma, Diabetes, dietary requirements) or any
other way your child may need extra support from staff
………………………………………………………………………………………………
………………………………………………………………………………………………
………………………………………………………………………………………………
Current medication………………………………………………………………………….
Home languages spoken……………………………………………………………………
It may be helpful to know which languages are spoken and written at home and if translation
would help communicate with parents.
Which sessions would you require for your child? Please tick
Day
Time
Monday
8.45am-12.10pm
Monday
8.45am-2.00pm
Tuesday
8.45am-12.25pm
Tuesday
8.45am-2.40pm
Wednesday
8.45am-12.10pm
Wednesday
8.45am-2.00pm
Thursday
8.45am-12.25pm
Thursday
8.45am-2.40pm
Friday
8.45am-12.10pm
Friday
8.45am-2.00pm
Age group
2 years 3 months
upwards
Price
Please tick
preference
£10.50
£17.00
LUNCH REQUIRED
Pre-school only*
LUNCH REQUIRED
EXTENDED
AFTERNOON
SESSION
2 years 3 months
upwards
£15.00
£18.00
£10.50
£17.00
LUNCH REQUIRED
Pre-school only*
LUNCH REQUIRED
EXTENDED
AFTERNOON
SESSION
2 years 3 months
upwards
£10.50
£18.00
£10.50
£17.00
LUNCH REQUIRED
What year will your child start school? ...............................................................................
Which school are you intending to send your child to?........................................................
At snack time we offer milk and water. If you have preference to which your child prefers
please state it here…………………………………………………………..
Does your child attend any other setting?......................................................................
…………………………………………………………………………………………
The Play leader and staff take children out during the session to the surrounding outdoor
area, the adjoining school playground and walks within the village. Please sign below if you
give your permission.
Signature………………………………………………………………(Parent/Guardian)
Playgroup staff will write observations and take photographs of the children to be used
within the setting, the playgroup website, and promotion of the setting and in the children’s
Learning Journals. Please sign below if you give permission for your child to be
photographed.
Signature…………………………………………………………..…(Parent/Guardian)
I consent to my child receiving medical treatment in the event of an emergency, including
contacting a doctor or taking my child to a hospital. If my child goes on a supervised trip I
understand I will be asked to fill in a separate form for each trip.
Signature…………………………………………………………………………………..
If consent is not given can you please state your reason below, (for example religious
beliefs) and what is required instead in the event of a medical emergency?
Reason………………………………………………………………………………………
………………………………………………………………………………………………
What is required instead…………………………………………………………………….
………………………………………………………………………………………………
Computer use in playgroup session time
Within the Early Years Foundation Stage curriculum, ICT plays an important part. We have
a computer for the children to use in Playgroup, and we always use age appropriate software
and games. We use a timer next to the computer, set to 5 minutes so it would never be the
case that an individual child would be in front of the screen for a long period of time.
We also make good use of a Kindle, which the children can take use to take pictures, play
educational games or look at books. This has proved a very fun and popular activity!
We have taken measures to ensure that Playgroup children will never have access to
unsuitable material on the internet,( we have NO internet access at Playgroup).
Please provide a signature below to confirm that you are happy for your child to take part in
ICT activities.
Signature………………………….…………………………………….(Parent/Guardian)
Date this form was completed……………………………………………………………..
Please return this form to:
King’s Stanley Playgroup,
King’s Stanley,
Stonehouse,
Gloucestershire,
GL10 3JA
King’s Stanley Playgroup, Church Street, King’s Stanley, Stonehouse,
Gloucestershire, GL10 3JA
Registered Charity Number; 1052016. Ofsted Registration No. 101487
Telephone 07974 589536