Newton Childcare Ltd - Registration Form Confidential
Personal Details
Childs Full Name
___________________________
Date of Birth
____________
Address (To where child resides) _______________________
_______________________
_______________________
Post Code
_______________________
Tel No#
_______________________
Email Address
_______________________
Nationality
_______________
Language Used at Home _______________
Emergency Contacts
Name
1 ________________
Relation to child
1 ________________
Address
1 ________________
1 ________________
1 ________________
Post Code
1 ________________
Home Tel No#
1 ________________
Work No#
1 ________________
Mob No#
1 ________________
2 ________________
2 ________________
2 ________________
2 ________________
2 ________________
2 ________________
2 ________________
2 ________________
2 ________________
Who has parental responsibility for your child? ______________
If any legal injunctions have been sort please attach official documentation, in the
event of police interaction.
Any Other Information (Such as dietary Requirements)
___________________________________________________________
___________________________________________________________
___________________________________________________________
Doctors Name
Doctors Address
Tel no#
__________________
__________________
__________________
__________________
__________________
Has your child got any allergies, ongoing health problems or
additional needs. If yes Please give details. (N.B. We operate a none
discrimination policy)
___________________________________________________________
___________________________________________________________
___________________________________________________________
______
Names of people who are authorised to collect your child
from Newton Childcare Ltd. (No child will be released to an unauthorized person)
___________________________________________________________
___________________________________________________________
___________________________________________________________
You may add photos if you wish
PHOTO
&
NAME
___________
PHOTO
&
NAME
___________
PHOTO
&
NAME
PHOTO
&
NAME
___________
___________
Any additional Information you think that Newton Childcare
Ltd Club should know?
___________________________________________________________
___________________________________________________________
Have you read the Special need Policy and Complaints
policy which is provided in the parent pack? Yes/No
I confirm all information is correct and I will contact Newton
Childcare Ltd of any changes immediately.
All policies can be obtained by email or a paper copy is available at
request. We advise all parents to read them before signing
Signed _________________________
Date _____________
Permission Form - Confidential
Childs Name ___________________
I give Permission for Newton Childcare Ltd staff to include my child
in photographs taken during the sessions and been used in media
to promote the Pre-School.
Signed __________________________
Date _____
I give permission for Newton Childcare Ltd staff to take my child on
outings around the school grounds (Permission will be sort for
excursions further a field)
Signed __________________________
Date ______
I give permission for my child to receive emergency medical
treatment if necessary.
Signed __________________________ Date ______
I give permission for staff to apply plasters to minor cuts and wounds
if deemed necessary
Signed __________________________ Date ______
I will provide my child with sun cream in the summer months when
necessary. I give permission for staff to administer sun cream in line
with “Sun protection Policy”, (If you do not wish for your child to use
sun cream please state on this form and sign and date).
Signed __________________________ Date ______
Invoice and Payment Terms
Please tick the sessions which you require
Monday
Tuesday
Wednesday
Thursday
Friday
Breakfast Club
After School Club
Add Hoc Only
Accounts are to be invoiced monthly in advance, Additional
sessions will be charged on the following months account
 Fees invoiced must be paid in full within 14 days of invoice date
unless prior arrangements have already been made
1. If payments haven’t been made within 14 days 5% interest
will be charged to the account
2. If a cheque is not honoured any administration and bank
charges will apply
 No refund can be made for holidays or non-attendance during
term time
 We welcome Add Hoc bookings from members, where childcare
spaces and staffing make this available – however all prebooked sessions must be paid for in line with this policy.
 Four weeks written notice must be given when the withdrawal of
a childcare place is required. Full fees must be paid for the four
weeks, weather the services of Newton Blues Out of School Club
are used or not
 We will try to accommodate change of sessions if required and
when they become available. Strict staff/child ratios will be
maintained at all times.
 In the event of invoices not been paid we have a policy in place
for take legal action when required.

Name of Child _________________________________
Year __________
I have read and understood the terms and conditions relating to
payments of fees and agree to abide by them.
Parent / Carer Signature _____________________________ Date __________
Please note – a new Invoice and payment agreement will be required
in the event of a change in childcare use