ENROLMENT FORM
PERSONAL DETAILS
NAME OF CHILD ……………………………………………………… D.O.B …………/…………../…………….
Name of which child should be addressed: ………………………………………………………………………………
Child’s first language: ………………………………………………………….………………………………………..
FAMILY NAME ………………………………………………………………………………………………………..
ADDRESS: ………………………………………………………………………………………………………………
………………………………………………..………………........................................................................................
POSTCODE: …….........................
TELEPHONE: ……………………………………………… E-MAIL: ………………………………………………..
Mother’s name: ……………………………………………… Occupation: ……………………………………………..
Tel No: ……………………………………………………… Mobile: ………………………………………………….
Father’s name: ……………………………………………… Occupation: ……………………………………………..
Tel No: …………………………………………………..… Mobile: ………………………………………………….
SPECIAL REQUESTS
Do you have any special requests about religious observance, food, clothing, health, fears or special words?
………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………..

MEDICAL HISTORY
NAME OF CHILD’S DOCTOR: ……………………………………………………………………………………..
ADDRESS……………………………………………………………………………………………………………
……………………………………………………………………………………………………………………….
…………………………………………………TEL NO …………………………………………………………….
Has your child had the following immunisations?
Diphtheria

Whooping Cough

Tetanus

Polio

MMR

HIBS

Is your child allergic to anything: …………………………………………………………………………………..
Does your child suffer from asthma: ………………………………………………………………………………..
Please state any medical history that you feel we should be aware of: ……………………………………………..
……………………………………………………………………………………………………………………….
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Our group has a special needs policy. Does your child have any special needs, which you would like to discuss?
……………………………………………………………………………………………………………………….
……………………………………………………………………………………………………………………….
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SCHOOLING
Does your child attend another pre-school or play group Yes

No

When is your child expected to start school: …………………………………………………………………………..
Which school (if known)………………………………………………………………………………………………

EMERGENCY CONTACT DETAILS: Please list 2 persons that we can contact in an emergency, should we be unable to contact main carer.
NAME …………………………………………………………………………………………………………………………….
ADDRESS: ……………………………………………………………………………………………………………………….
…………………………………………………………………………….. TEL NO ……………………………………………
Relationship to child ………………………………………………………………………………………………………………
NAME …………………………………………………………………………………………………………………………….
ADDRESS: ……………………………………………………………………………………………………………………….
…………………………………………………………………………….. TEL NO ……………………………………………
Relationship to child ………………………………………………………………………………………………………………
Please list below the names of persons authorised to collect your child from pre-school:
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ANY FURTHER INFORMATION
ETHNIC CATEGORY FORM


PROVIDER: Westwood Montessori
URN: EY337582
NAME OF CHILD:………………………………………………………………………
PLEASE TICK ONE BOX ONLY
ASIAN / ASIAN BRITISH

WHITE










British
Irish
Traveller of Irish Heritage
Gypsy/Roma
Albanian (ex Kosovan)
Italian
Kosovan
Greek/Greek Cypriot
Turkish/Turkish Cypriot
White Eastern European

(inc. Bulgarian, Czech, Latvian, Lithuanian
Polish, Romanian, Russian, Slovak, Ukranian)
White Western European
(inc. French, German, Spanish, Portuguese




Indian
Pakistani
Bangladeshi
Nepali
African Asian
 Other Asian
Scandinavian)
White other
(Other children of White background not
Represented in the categories above)
BLACK OR BLACK BRITISH




Caribbean
Nigerian
Other Black African
Any other Black background
 Chinese


Thai
Vietnamese
MIXED/DUAL BACKGROUND





White and Black Caribbean
White and Black African
White and Asian
White and any other ethnic group
Other mixed background
ANY OTHER ETHNIC BACKGROUND




Afghanistani
Filipino
Any other ethnic group
I DO NOT WISH AN ETHNIC BACKGROUND TO BE RECORDED.

Dear Parents
There are key elements in the life of our Pre-School where parents and the wider community will naturally wish to have a visual record of the proceedings.
Unfortunately, the actions of the minority in the misuse of visual images and recordings, in particular through the use of the internet and social network sites have meant that local authorities and schools need to pay particular attention to the requirements of data protection legislation.
We therefore need to have your permission to continue to allow photography and recordings within the preschool setting.
We would advise that all such visual images and recordings should be for personal use only and any photographs or recordings showing children other than your own should NOT be posted on any social network sites or blogs.
It is necessary for every parent to sign and return the following information for each child. The following applies to events in and out of school (e.g. school trips).
KINDLY NOTE: Unless all parents agree to 4 photography/ video recordings will not be allowed at school open events.
Thank you for your support in this matter.
1.
I have no objection to my child __________________ (print name) being photographed by official photographers invited to do so by the school. (e.g. school photographers, newspapers etc)
Signed……………………………………………… Print Name…………………………………………
2.
I have no objection to my child __________________ (print name) being photographed by school staff for school purposes. (e.g. notice boards, inclusion in exercise books, open events, etc)
Signed……………………………………………… Print Name…………………………………………
3.
I have no objection to my child __________________ (print name) being photographed by school staff for the purposes of publication in the school brochure or newsletters etc.
Signed……………………………………………… Print Name…………………………………………
4.
I have no objection to my child __________________ (print name) being photographed or video recorded by parents, grandparents or relatives of the school at open events such as fun day, school presentations etc.
Signed……………………………………………… Print Name…………………………………………

DECLARATION
Please sign below to give us permission to take your child on local nature walks or visits, while in our care:
YES/NO *
Signed ………………………………………………………………… Date …………………………….
Please sign below to give us permission to administer basic first aid, including the application of plasters, should the need arise:
YES/NO*
Signed......................................................................................................Date............................................
Please sign below to give us permission to seek medical advice and treatment, should the need arise:
YES/NO *
Signed ………………………………………………………………… Date ………………………………
I agree to staff applying suntan lotion when appropriate:
YES/NO *
Signed ………………………………………………………………… Date ………………………………
I agree to my child consuming birthday cakes brought in by other children
YES/NO*
Signed....................................................................................................... Date................................................