Application to
register as a day
care provider
Before completing this application form please familiarise yourself with the following
legislation:

Part 2 of the Children and Families (Wales) Measure 2010

The Child Minding and Day Care (Wales) Regulations 2010

The Child Minding and Day Care (Disqualification) (Wales) Regulations 2010

National Minimum Standards for Regulated Child Care
These can be found at www.cssiw.org.uk.
The application form is divided into two distinct parts. Both parts must be completed in full.
A checklist of additional documents that must be submitted with the application is included
at the end of the application form.
Please tick preferred language of communication:
Welsh
English
Both
For office use only: QA number:
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Details of the proposed service
Name and address of proposed service
Post code
Telephone number
E-Mail address of the proposed service
Fax number (if any), of the premises where the
children are to be looked after - Paragraph 26,
Schedule 2
Type of service you are applying to register:
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Full day care
Sessional day care
Crèche
Out of school care
Open access play provision
Are you applying to register as an
Individual?
Organisation?
Organisation” means a body corporate or an unincorporated association (Regulation 2(1))
If you are an individual applicant please complete Section A below.
If you are an organisation please go straight to Section B.
All applicants must complete Sections D, E, and F within Part 1 of the application and Part 2 of the
application including Section G.
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Part 1
About you, the care you want to
provide, your premises and
information about other persons who
will work with you or who may live or
work on the premises
Section A: Application made by an individual
Details asked for in this section are required under the Child Minding and Day Care (Wales)
Regulations 2010 Schedule 2, Part 2, Paragraph 22
A1. This section should be completed by each individual who is proposing to be
registered to provide the service and you should make as many copies of this
section as required before you complete the form. If this application is being
made by an organisation, please move to Section B
Title
Mr
Mrs
Ms
Miss
Other: Please specify:
Your full name
Any aliases and former names
Date of birth
Your address
Post code
Telephone number
Email address
Do you intend to be in full day to day charge of the provision of
day care?
Yes
No
If the answer is no, you are required to appoint a suitable person in charge who must complete
section C of this application.
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A2. Qualifications and experience
Schedule 1, Part 2, Paragraph 1 7 a n d Schedule 2, Part 2, Paragraph 22(3)
Details of your professional / technical qualifications that are relevant to the provision of day care for
children under the age of 8: Schedule 2, Paragraph 22(3).
Please tell us here about any experience you have had that you think will support your application to
provide a day care service for children under the age of 8: Schedule 2, Paragraph 22(3).
A3. Please provide details below of any business you are carrying on at present
or that you have carried on in the past.
Schedule 2, Paragraph 22(4)
Details of business
Dates you carried on this business
A4. Your work history
Schedule 2, Paragraph 22(5)(a)(b)(c)
Please provide details of your employment history covering the period between leaving school and
now, including the year and month of each change of occupation. Remember to include periods of
study and volunteering.
Where there are gaps in employment please explain, giving enough detail of the circumstances to
enable checks to be made, if necessary.
Please be sure to include any experience you consider to be relevant to the present application
including any previous work with children whether paid or not.
If any of your previous duties involved working with children, give the full reasons why your
employment or position ended and please explain how this can be confirmed.
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Employment
(job title)
From
month/year
mm/yyyy
mm/yyyy
mm/yyyy
mm/yyyy
mm/yyyy
mm/yyyy
mm/yyyy
mm/yyyy
mm/yyyy
mm/yyyy
To
month/year
mm/yyyy
mm/yyyy
mm/yyyy
mm/yyyy
mm/yyyy
mm/yyyy
mm/yyyy
mm/yyyy
mm/yyyy
mm/yyyy
Reason for leaving
Name, address & Tel
no. of employer
A5. Please supply the names and addresses of two individuals from whom we
will take up references
You are not required to provide references if you are not intending to be in full day to day charge of
the children in the registered setting
Schedule 2, Part 2, Paragraph 22(5)(d)
The people you name must not be related to you. Both of these referees must be able to comment on
your competence to look after children under the age of 8. Where possible, one of the referees should
be your most recent employer. You should give the name of your most recent employer as the first.
Reference 1
Name
Address
Post code
Occupation
Telephone number
In what capacity are you known to them
e.g. employee, friend, colleague and
how long have they known you?
Reference 2
Name:
Address
Post code
Occupation
Telephone number
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In what capacity are you known to them
e.g. employee, friend, colleague and
how long have they known you?
A6. Medical practitioner report
Schedule 1, Part 2, Paragraph 18 and Schedule 2, Part 2, Paragraph 20
You are required to provide a report by a registered medical practitioner as to your physical and
mental fitness to look after children under the age of 8.
This must be submitted as part of your application. A template for this reference is attached.
(Appendix 1)
If you are unable to obtain this report please explain why and provide a statement on a separate
sheet as to the state of your physical and mental health.
A7. Disclosure and Barring Service (DBS) check
Schedule 1, Part 2, Paragraphs 19 & 20
You are required to provide a completed DBS application form when you file your application to
register with CSSIW. (This must be countersigned by CSSIW on behalf of the Welsh Ministers.)
Application forms are available from CSSIW regional offices.
A8. Additional Personal Information
The following information is requested under the Children and Families (Wales) Measure 2010 and
the Child Minding and Day Care (Disqualification) (Wales) Regulations 2010. A copy can be found at
www.cssiw.org.uk
Please note: You are disqualified from registration as a provider of day care or from being directly
concerned in the management of any provision of day care in Wales if you or any person living or
working in your household is disqualified under the Child Minding and Day Care (Disqualification)
(Wales) Regulations 2010.
CSSIW will carry out various checks, including the Disclosure and Barring Service check, local
authority social services departments, and its own records.
A person is able to apply for a waiver from disqualification in certain circumstances.
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Have you or any person who lives or works in your household ever:
 been refused registration in respect of a children’s
home or voluntary home?
 had your registration in respect of a children’s home
or voluntary home cancelled?
Yes
No
Yes
No
Yes
No
 been concerned in the management of, or had any
financial interest in a children’s home or voluntary
home in respect of which another person has had
their registration cancelled?
If you answered Yes to any of the above please provide the names of the person involved, details of
the relevant registration authority, name and address of the home, nature of the person’s connection
with the home, type of action taken against the person and the date of any such action.
Have you or any person who lives or works in your household ever:
 been refused registration in respect of the provision
of nurseries, day care, child minding or other
provision of day care?
Yes
No
 been disqualified from registration in respect of the
provision of nurseries, day care, child minding or
other provision of day care?
Yes
No
Yes
No
 had registration cancelled in respect of the provision
of nurseries, day care, child minding or other
provision of day care?
If you answered yes to any of the above please provide the names of the person involved, details of
the registration authority, name and address of the provision, nature of the person’s connection with
the provision, type of action taken against the person and the date of any such action.
Have you or anyone who lives or works in your
household ever been disqualified from fostering a
child privately?
Yes
No
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If yes, please provide brief details here, including the name of the person and date:
Do you know of any other reason why you maybe disqualified from
registration as a day care provider under the Child Minding and Day
Care (Disqualification) (Wales) Regulations 2010?
Yes
No
If you answered yes please provide details here:
Please be aware that a failure to disclose a matter which would disqualify you from registration as a
provider of day care may affect your ability to be granted a waiver.
Social services check
Please complete the attached consent form which authorises CSSIW to contact social services
departments for information. (Appendix 2)
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Section B: Application made by an organisation
(e.g. registered company/local authority/limited liability partnership or unincorporated
association)
B1 Details asked for in this section are required under the Child Minding and Day
Care (Wales) Regulations 2010
Schedule 2, Part 2, Paragraph 23
Name of organisation
Address of organisation
Post code
Telephone number
Email address of the organisation
Fax number of the organisation
B2. In the case of an applicant organisation which is a company, please provide
the following information
Schedule 2, Part 2, Paragraph 23(3)
Registered office address, post code
or principal office of the company
Registered company number:
Registered charity number (if applicable):
B3. If the organisation is a subsidiary of a holding company1, please provide the
following information
Schedule 2, Part 2, Paragraph 23(4)
Name and address, post code of the holding
company
Name and address, post code of the registered or
principal office of the holding company
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Name and address, post code of any other
subsidiary of the holding company
B4. You are required to provide the additional information listed below with your
application
Schedule 2, Part 2, Paragraphs 43 to 45



Copies of the last two annual reports for your organisation
If your organisation is a subsidiary of a holding company you will need to attach copies of the last
two annual reports (if any) of the holding company and of any other subsidiary of the holding
company
The last annual accounts of the organisation, if any.
1
The words ‘holding company’ and ‘subsidiary’ are to be interpreted in accordance with Section 1159 of the Companies Act
2006
B5.1 Nominated responsible individual
Schedule 1, Part 2, Paragraphs 21 to 25
This section should be completed by the person nominated as the responsible individual.
[A responsible individual is responsible for the supervision and management of the provision of day
care. In relation to a body corporate, the responsible individual must be a director, manager,
secretary or other officer of that organisation. In relation to an unincorporated association, the
responsible individual must be an officer or member of that organisation’s governing body. The
following personal information relates to the nominated responsible individual].
B5.2
Schedule 2, Part 2, Paragraph 24(2)
Title
Mr
Mrs
Ms
Miss
Other: Please specify
Full name
Any aliases and former names
Position held in the organisation
Date of birth
dd/mm/yyyy
Address
Post code
Telephone number
Email address
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B5.3 Qualifications and experience
Schedule 1, Part 2, Paragraph 22 / Schedule 2, Part 2, Paragraph 24(3)(a) & (b)
Details of your professional / technical qualifications that are relevant to the provision of day care for
children under the age of 8:
Please tell us here about any experience you have had that you think will support this application to
provide a day care service for children under the age of 8.
If there is to be a person in charge please state your qualifications and experience relevant to the
supervision and management of the provision of day care.
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B5.4 Your employment history
Schedule 2, Part 2, Paragraph 24(4)(a)(b)(c)
Please provide details of your employment history covering the period between leaving school and
now, including the year and month of each change of occupation. Remember to include periods of
study and volunteering.
Where there are gaps in employment please explain, giving enough detail of the circumstances, to
enable checks to be made if necessary. Please be sure to include any experience you consider to be
relevant to the present application including any previous work with children whether paid or not.
If any of your previous duties involved working with children, give the full reasons why your
employment or position ended and please explain how this can be confirmed.
Employment
(job title)
From
month/year
To
month/year
Reason for leaving
Name, address & Tel
no. of employer
Please continue on a separate sheet
Please use the space below to explain any gaps in your employment record above (include dates).
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B5.5 Please supply the names and addresses of two individuals from whom we
will take up references
Only required if you intend to also be the person in charge
Schedule 2, Part 2, Paragraph 24(4)(d)
The people you name must not be related to you. Both of these referees must be able to comment on
your competence to look after children under the age of 8. Where possible, one of the referees should
be your most recent employer. You should give the name of your most recent employer as the first.
Reference 1
Name
Address
Post code
Occupation
Telephone number
In what capacity are you known to them
e.g. employee, friend, colleague and how
long have they known you?
Reference 2
Name
Address
Post code
Occupation
Telephone number
In what capacity are you known to them
e.g. employee, friend, colleague and how
long have they known you?
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B5.6 Medical practitioner report
Schedule 1, Part 2, Paragraph 23 and Schedule 2, Part 2, Paragraph 46
You are required to provide a report by a registered medical practitioner as to your physical and mental
fitness to look after children under the age of 8. A template for this reference is attached.
(Appendix 1)
This must be submitted as part of your application.
If you are unable to obtain this report please explain why and provide a statement on a separate sheet
as to the state of your physical and mental health.
B5.7 Disclosure and Barring Service (DBS) check
Schedule 1, Part 2, Paragraphs 24 and 25
You are required to provide a completed DBS application form when you file your application to
register with CSSIW. (This must be countersigned by CSSIW on behalf of the Welsh Ministers.)
Application forms are available from CSSIW regional offices.
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Section C. Information about the person in charge
Schedule 1, Part 2, Paragraphs 26 to 31 and Schedule 2, Part 2, Paragraph 25
This section applies to a person in charge who is not the applicant or the responsible
individual.
C1a.
Paragraph 25(2)
Title
Mr
Mrs
Ms
Miss
Other: Please specify:
Full name of the person in charge
Any aliases and former names
C1b.
Paragraph 25(2)
Date of birth
Address
Post code
Telephone number
Email address
C2. Qualifications and experience
Schedule 1, Part 2, Paragraph 28 and Schedule 2, Paragraph 25(3)
Details of professional / technical qualifications that are relevant to the provision of day care for
children under the age of 8
Please tell us here about any experience the person in charge has had that you think will support this
application.
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C3. Work history
Schedule 2, Part 2, Paragraph 25(4)(a)(b)(c)
Please provide details of the person in charge’s employment history covering the period between
leaving school and now, including the year and month of each change of occupation. Remember to
include periods of study and volunteering.
Where there are gaps in employment please explain, giving enough detail of the circumstances, to
enable checks to be made if necessary.
Please be sure to include any experience you consider to be relevant to the present application
including any previous work with children, whether paid or not.
If any previous duties of the person in charge involved working with children give the full reasons why
the employment or position ended and please explain how this can be confirmed.
Employment
(job title)
From
To
Reason why employment Name, address & Tel
month/year month/year ended
no. of employer
mm/yyyy
mm/yyyy
mm/yyyy
mm/yyyy
mm/yyyy
mm/yyyy
mm/yyyy
mm/yyyy
mm/yyyy
mm/yyyy
mm/yyyy
mm/yyyy
mm/yyyy
mm/yyyy
mm/yyyy
mm/yyyy
mm/yyyy
mm/yyyy
mm/yyyy
mm/yyyy
mm/yyyy
mm/yyyy
mm/yyyy
mm/yyyy
mm/yyyy
mm/yyyy
mm/yyyy
mm/yyyy
Please continue on a separate sheet
Please use the space below to explain any gaps in employment record above (include dates)
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C4. Please supply the names and addresses of two individuals from whom we will
take up references
Schedule 2, Paragraph 25(4)(d)
The people named must not be related to the person in charge. Both of these referees must be able to
comment on the competence of the person in charge to look after children under the age of 8. One of
the referees should be their most recent employer, whose name should be given first.
Reference 1
Name
Address
Post code
Occupation
Telephone number
In what capacity are you known to them
e.g. employee, friend, colleague and how
long have they known you?
Reference 2
Name
Address
Post code
Occupation
Telephone number
In what capacity are you known to them
e.g. employee, friend, colleague and how
long have they known you?
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C5. Medical Practitioner report
Schedule 1, Part 2, Paragraph 29, Schedule 2, Part 2, Paragraph 46
You are required to provide a report by a registered medical practitioner as to the physical and mental
fitness of the person in charge to look after children under the age of 8. A template for this reference is
attached. (Appendix 1)
This must be submitted as part of your application.
If you are unable to obtain this report please explain why and provide a statement on a separate sheet
as to the state of the physical and mental health of the person in charge.
C6. Disclosure and Barring Service (DBS) check
Schedule 1, Part 2, Paragraphs 30 and 31
You are required to provide a completed DBS application form in respect of the person in charge when
you file your application to register with CSSIW. (This must be countersigned by CSSIW on behalf of
the Welsh Ministers.)
Application forms are available from CSSIW regional offices.
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Section D: Information about the care provided including details of the
premises
Schedule 2, Part 2, Paragraphs 26 to 32
Please provide the following details in respect of the premises at which children are to be looked after.
Schedule 2, Part 2, Paragraph 26
Name
Address
Post code
Telephone number
Fax number, if any
Email address, if any
Statement of Purpose
Schedule 2, Part 2, Paragraph 27
You are required to submit a Statement of Purpose with this application. The information that you must
include in your Statement is prescribed in Regulation 15(1) of the Child Minding and Day Care (Wales)
Regulations 2010.
Please provide details below of the proposed hours you wish to be registered for to provide day care
for children.
Schedule 2, Part 2, Paragraph 28
Monday between
Tuesday between
Wednesday between
Thursday between
Friday between
Saturday between
Sunday between
and
and
and
and
and
and
and
Are you the owner of the proposed day care premises?
If no, are the premises
leased?
hours
hours
hours
hours
hours
hours
hours
Yes
No
rented?
Who owns the property?
If leased or rented how much notice is required to vacate the
premises?
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Are the premises purpose built or have they been converted for day care?
For each room you intend to use, please fill in the following details using metres and centimetres
where measurements are required:
Storey eg basement/ Use of room
ground/first floor etc (eg baby,
playroom)
Measurement
Type of heating
(Reg 25)
Window
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Kitchen facilities
Storey
Proposed use:
(i.e. food preparation, baby milk, utility room, kitchen)
Toilet facilities (including staff/disabled)
Storey
Toilets
(indicate number for
children (CH); adult (AD);
disabled (DIS)
Wash hand basin
(indicate number)
Nappy change areas
Yes/No
Yes
No
Yes
No
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How do you intend to manage the disposal of nappies/ clinical waste? (Regulation 25)
How do you propose to provide or manage laundry facilities? (Regulation 25)
Outside play space(s)
(Regulation25/37)
Type of surface
How are the perimeters of the site secured?
Please include a description of the area in which your premises are located including facilities for
parents to drop off and collect their children. (Regulation 37)
You are required to submit an up to date plan of the premises with this application. (Regulation 37)
If no plan is available you will need to draw one and mark the actual dimensions of each room on it in
metres and centimetres. This will assist us in considering your application. The drawing need not be
to scale, but should accurately show the size(s) and positions of windows, internal doors between
rooms, stairs and exits to the open air.
Are you required to obtain planning permission for
childcare in the premises?
Yes
No
If yes, has planning permission been granted?
Yes
No
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CSSIW needs to be satisfied all parts of the premises to be used by the children are secure from
unauthorised access. (Regulation 37)
Please state below the security arrangements at the premises including:


for the purposes of safeguarding access to information held there, (Schedule 2, Paragraph 30a)
and
for the purposes of restricting access from adjacent premises or, when the premises form part of a
building, from other parts of the building (Schedule 2, Paragraph 30b).
Is it intended that any business or activity be carried on in the
premises at the same time as children are looked after there?
Yes
No
If yes please provide details below: (Schedule 2, Part 2, Paragraph 31)
Please use this space to add any further information about the facilities which you believe may be
relevant to your application.
Details of the children for whom care is to be provided
Please tell us about the number of children for whom care is to be provided and their ages:
Schedule 2, Part 2, Paragraph 32
Age range
Birth to 2 years
2 to 3 years
4 to 5 years
6 to 8 years
8 years and above
Insert number
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Do you intend to care for children overnight?
Yes
No
Section E: Information about other persons: staff
Schedule 2, Part 2, Paragraphs 33 and 34
Registered persons must ensure that they comply with Regulation 28 of the Child Minding and Day
Care (Wales) Regulations 2010 in respect of their appointment of staff, and obtain the information
specified in Part 2 of Schedule 2 to these Regulations.
Please provide the required details below for each person (other than the responsible individual and
person in charge) who cares for, or who is to care for, the children for whom day care is provided.
Separate sheets may be required.
Full name
Aliases and former names
Date of birth
Duties and responsibilities in relation to that person’s work
Will this person be resident on the premises?
Yes
No
Is this person a relative of yours?
Yes
No
If yes please state the nature of the relationship
Will this person be working:
Full time?
Part time?
If part time how many hours per week?
Date on which the person commenced work or is
intended to commence work
Details of this person’s qualifications, experience and skills relevant to the work they are to perform
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The applicant must complete the following statement in relation to each staff member
Schedule 2, Part 2, Paragraph 34(g) - (l) unless otherwise stated
Name of staff member:
I confirm that I am satisfied with the authenticity of this
person’s qualifications
Yes
No
I confirm that I have verified this person’s experience and
skills
Yes
No
I am satisfied that this person has suitable qualifications for
the work they are to perform
Yes
No
I am satisfied that this person has the necessary skills for
such work
Yes
No
I am satisfied that this person is fit to work and have regular
contact with children under the age of 8
Yes
No
I have received a written statement from this person
regarding their physical and mental health
Yes
No
I have received a statement from this person that they are
physically and mentally fit for the purposes of the work they
are to perform
Yes
No
I am satisfied as to this person’s identity
Yes
No
I have been provided with a copy of this person’s birth
certificate
Yes
No
I have a recent photograph of this person
Yes
No
I confirm that an enhanced criminal record certificate has
been issued for this person in respect of which less than 3
years have elapsed since it was issued. Paragraph 42(1)(a)(i)
Yes
No
I have obtained two references relating to this person and am
satisfied to the authenticity of these references
Yes
No
I will make the DBS certificate available for inspection by
CSSIW. Paragraph 42(2)(b)
Yes
No
Yes
No
Yes
No
I have a full written employment history for this person and a
satisfactory explanation for any gaps in their employment
record
I have verified why employment or the position ended when
this person was previously employed to work with children
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If unable to do this verification, please explain why below:
Section F: Information about all other persons
Other than a responsible individual, person in charge, or staff member employed by you to
care for the children, does anyone else, aged 16 years or over, work or live at the premises, or
otherwise visit the premises, who is likely to have regular contact with the children you will be
looking after? (This includes a person who works on a voluntary basis)
Yes
No
If no go to Section G at the end of Part 2 of the application.
If yes, then, in respect of all such persons you will need to supply the following personal details and the
person may need to have an enhanced Disclosure and Barring Service criminal record check.
This information is requested under Schedule 2, Part 2, Paragraphs 35 to 37
Full name of adult including any
alias and former name
Date of birth
(dd/mm/yyyy)
Address (if different from the
premises address)
(Please continue on a separate sheet if necessary)
I confirm that an enhanced DBS criminal record certificate
has been issued in respect of each of the above named
persons.
Yes
No
If no please note that you will be responsible for ensuring any such persons are appropriately
supervised at all times when in contact with the children being looked after.
I confirm I will make the above DBS criminal record
certificates available for inspection by CSSIW. Paragraph
42(2)(b)
Yes
I confirm that where I am not entitled to receive any of the above
information, I will ensure that any persons aged 16 years or over who work,
live or are otherwise present at the premises and likely to have regular
contact with the children will be appropriately supervised at all times when
in contact with the children.
No
Yes
No
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Part 2
Meeting the regulations
and standards
Introduction
This section of your application is to be completed by the applicant (in the case of an organisation this
will be the person nominated as responsible individual) and is your opportunity to show that you have
understood the principles and requirements expressed in the regulations (The Child Minding and Day
Care (Wales) Regulations 2010), and the National Minimum Standards for Regulated Child Care
(NMS). You must use this part of the application form to describe the arrangements and resources you
will use as a day care provider to comply with the regulations and improve your service over time.
There are eight sections to the National Minimum Standards:

Information on service

Planning for individual needs and preferences

Empowering service users and encouraging life style choices

Quality of care

Staffing

Conduct and management of the service

Complaints, protection and other significant events

The physical environment
You need to consider how you will promote equality and diversity under each of the headings above.
Each section identifies which regulations and NMS you need to meet and what information you must
provide to CSSIW to demonstrate that you are prepared for registration as a day care provider. There
is also reference to Annex A and B in the NMS which you need to take account of if you intend to
provide overnight care or nursery school provision to children. Throughout the form where the term
‘parent’ is used it also means the ‘main carer’ of a child.
It is essential in preparing your application that you read the regulations, which the law requires you to
meet, and NMS. These can be found on our website: www.cssiw.org.uk
Guidance is given on the website, and you may also want to contact your local authority or Family
Information Service.
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Section One - Information on service
Information and written contract (including Annex A Overnight Care a.11/a.12) Not mandatory
for open access play provision
Relevant Regulation 15
Outcomes
Linked NMS
(Refer to Annex A 1 & 2
& B if appropriate)

Parents have all the information they need to make an informed
choice about the child care service they require.

Parents have a written contract they have agreed with the registered
person.

You must provide a written statement of purpose which describes your day care service and how
it will operate, providing information for anyone wishing to use it. The content of your Statement of
Purpose is prescribed in Regulation 15 and NMS 1

You must also provide a written contract that sets out the expectations of parents regarding the
care of the child, activities provided and business arrangements. You should make sure your
contract covers all the information in NMS 2. An agreed and signed contract with the parent/carer
must be in place for every child.
Please tell us below how you will provide parents with this information (Statement of Purpose and
contract) and how often you intend reviewing/updating this information
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Please provide a copy of your Statement of Purpose (Regulation 15, NMS 1.2)
Inspector’s comment box
Signed
Date
08/2013
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Section Two - Planning for individual needs and preferences
Assessment, meeting individual needs and keeping records. Some information is not
mandatory for open access play provision - check with the NMS.
15, 20, 21, 22,
23, 24 26 29 30
Relevant Regulations 31, 32, 37 and
Schedule 3
Linked NMS
3, 4 & 5

All children have their needs and preferences identified and their
parents know how these will be met

Each child’s individual needs, including any special educational
needs and disabilities, are planned for and provided for

Parents and CSSIW have access as appropriate to a full range of
records maintained by the registered person for the smooth running
of the setting.
Outcomes

The assessment: you must develop a form to use with parents that will make sure you understand
each child’s needs, what parents expect from you and confirmation that your service will be able
to meet these needs and expectations

You must prepare a policy that describes how you will assess, plan for and meet any special or
additional needs children in your care may have and include how you will make sure that staff
employed will meet this standard

You must ensure that you keep records as required by Regulation 30 and Schedule 3 of the Child
Minding and Day Care (Wales) Regulations 2010.
Please tell us below:

what you would consider with parents to ensure that you will be able to meet each child’s
individual needs and preferences

how you will ensure that your staff have the necessary skills and experience to plan for and meet
each child’s individual needs and preferences

how you will ensure information about each child is kept up-to-date

how you will store these confidential records.
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Please provide a copy of your special needs policy (NMS 4.6)
Inspector’s comment box
Signed
Date
08/2013
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Section Three - Empowering service users, encouraging life style
choices
Working in partnership with parents (including Annex A a.9 & a.10) and opportunities for play
and learning
6&7
16, 32, 20, 27 & 37
Relevant Regulations
Outcomes
Linked NMS
including Annex A a.9 &
a.10 if appropriate

Parents are kept fully involved in and informed about their child’s
activities, achievement and progress

Children have a range of experiences - including freely chosen,
unstructured and self directed play that contribute to their emotional,
physical, social, intellectual, language and creative development.
Parents’ primary responsibility for their children must be recognised and respected. They must be
fully informed about the day care setting’s routines and child care practices.
Please tell us below how you will:

keep parents informed and involved in the care of their child

seek feedback from parents about the service you are providing

listen to children and value their contribution

help children to cope with new situations; help them to explore and use their imagination

manage risk
Also, describe what resources, play opportunities and activities you intend to provide including
babies’ activities.
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Please provide a copy of your confidentiality policy
Inspector’s comment box
Signed
Date
08/2013
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Section Four - Quality of care
Nurture and wellbeing, behaviour, health care, medication and food and drink
20, 21, 23, 24, 25,
Relevant Regulations 26, 27, 29, 30,
31 & 37
Linked NMS
8, 9, 10, 11 & 12
including Annex a.9 &
a.8 if appropriate

Children feel secure, happy and comfortable with their carers and
in their environment, and their rights are respected

The behaviour of children is managed in a way that respects their
rights and promotes their welfare and development

The health care needs of each child are identified and addressed
as appropriate and children benefit from the way in which good
health is promoted

Children are safeguarded by the setting’s policies and procedures
about medication, and receive the medication they need

Children are provided with regular drinks and food in adequate
quantities for their needs.
Outcomes
You must prepare the following:

a written behaviour management policy stating the methods used to manage children’s
behaviour: This should include a statement on how you will deal with bullying

a written policy describing your procedure and management for storing and administering
medication

a written procedure that describes what action you will take if a child becomes lost/missing or is
not collected.
You must:

ensure that at all times there is at least one member of staff with a current first aid at work
certificate on the premises

ensure that at least 50 per cent of staff on the premises at any one time are trained in first aid for
infants and young children

keep a first aid box

keep a record of any medicine administered to a child

prepare a form for parents to give their consent for you to give medicine to their child.
If you are providing food for children you need to contact the Food Standards Agency in order to
register with them.
It is good practice to have training in basic food hygiene - you need to contact your local Family
Information Service to arrange this.
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We advise that you plan a healthy eating menu for the children in your care, taking account of
individual needs and preferences.
You must ensure that staff are aware of the United Nations Convention on the Rights of the Child and
its implications for their interaction with children.
Please tell us in the box below how you would:

settle children into your day care setting

manage children’s unacceptable behaviour and tackle any instances of bullying

raise any concerns with parents about a child’s behaviour

promote good health of the children you look after and prevent the spread of infection and what
you would do if any child is ill, or has to be excluded due to illness

record a child’s health needs and any observations or concerns you may have, and how these will
be raised with parents

identify the risks around the administrating of medication and how you would seek advice and
training, if required

respond to any medical emergencies

manage mealtimes, provide a balanced and nutritious diet that takes account of individual needs,
preferences and any food allergies.
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Please provide copies of your:

Behaviour management policy (Regulation 23, NMS 9.2)

Medication policy (NMS 11.5)

Lost/missing/not collected procedure (Regulation 30 and Schedule 3, Paragraph 13)

First aid certificates (Regulation 24(2)(b) and NMS 10.14)
Inspector’s comment box
Signed
Date
08/2013
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Section Five - Staffing
Suitable Person (Reference to NMS Annex B Nursery Schools if applicable)
Relevant Regulations 6, 9, 27, 28, 29
Outcomes
Linked NMS
13 (DC)
Children’s needs are fully met by those who look after them.

The registered person must ensure that all staff employed are suitable to look after children under
the age of 8. You are asked to provide evidence of this in Part 1 of this application

The registered person must ensure staff have adequate training, including induction training in
their first week of employment, one to one supervision and an annual appraisal

You must prepare a written policy and procedure for staff discipline.
Please provide information below about:

your knowledge of child development and how you propose to keep up-to-date with any changes
in this area

how you will ensure that your staff team remain suitably qualified and skilled to safeguard and
promote the welfare of children

your arrangements for supervision and appraisal of all staff.
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Please provide a written policy and procedure for staff discipline (Regulation 29)
Inspector’s comment box
Signed
Date
08/2013
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Section Six - Conduct and management of the service
Organisation, staffing ratios (including NMS Annex A and B if applicable), equal opportunities,
financial procedures and quality assurance
Relevant Regulations
Outcomes
6, 9, 15, 16, 17, 18,
20, 27, 28, 32, 33,
Linked NMS
14, 15, 16, 17, 18

Parents and children benefit from a well organised and planned day
care service

Children benefit because the ratio of adults to children conforms to
best practice

All children are treated with equal concern and respect

Children and their parents are safeguarded by the registered person
operating sound financial procedures

Children and their parents benefit from a quality service that is
effectively monitored.
You must 
Have appropriate public liability insurance (Schedule 2, Part 2, Paragraph 41 and NMS 17.2).

Set up and keep a system for monitoring and improving the quality of care given to children
(Regulation 16). The quality of care must be reviewed annually and you must obtain the views of
children, parents, staff and other significant persons. You will be required to complete a Self
Assessment of Service Statement (SASS) form, which is issued by CSSIW every year (Regulation
17). This will be accepted as your annual review of quality of care providing it meets the
requirements of Regulation 16 and is in such a format that can be understood by parents and
other significant persons.
CSSIW may make requirements about your service - you must let CSSIW know that you have
completed them by the given date. (Regulation 18)
You should:

prepare a written policy that explains how you promote equality of opportunity and antidiscriminatory practice

develop and periodically review an operational plan (refer to NMS 14.1 for content)

ensure any vehicle used to transport children is roadworthy and has appropriate car insurance
which includes business use

keep a record of all financial transactions for your business.
Please tell us below:

what you understand to be the role and responsibilities of the registered person
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
what you understand to be the role and responsibilities of the person in charge

about the activities and resources you will develop and use to help children understand and learn
about a wide range of people and cultures in our society

how you will monitor the quality of your service and seek the views of children, parents and other
interested parties on the quality of care you provide.
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Please provide copies of the following:

your equal opportunities policy (NMS 16.2)

your operational plan (NMS 14.1 and 21.11)
Inspector’s comment box
Signed
Date
08/2013
Page 42 of 59
Section 7 - Complaints, protection and other significant events
Complaints, safeguarding and child protection and notifying CSSIW of changes/significant
events
10, 11, 15, 22, 23,
Relevant Regulations 28, 31, 32, 33, 34,
35, 36
Outcomes
Linked NMS
19, 20 & 21

Children and their parents are confident that their complaints will be
listened to, taken seriously and acted on

Children are protected from harm and abuse and parents are
confident that all reasonable steps to protect children from abuse
are taken.
You must

have a written complaints procedure in line with the regulations which inform parents how you will
deal with any concerns they have, and what you will do if they are not satisfied. (Regulation 32)

keep a record of all complaints. (Regulation 33 (5))

ensure that parents are aware that CSSIW is the organisation that registers and inspects your
service and give parents the contact details for the local CSSIW office. (Regulation 32(6))

provide a written child protection policy that links into the arrangements of the Local Safeguarding
Children Board (LSCB) and identifies how to access the All Wales Child Protection Procedures.
The policy must include local contact telephone numbers for reporting concerns you might have
about a child in your care. (Regulation 22)

notify CSSIW of the occurrence of any of the events listed in Schedule 4 of the Child Minding and
Day Care (Wales) Regulations 2010 and other requirements for notification. A notification form
which lists all notification requirements is available on the CSSIW Internet site.
Please tell us below:

how you would deal with a concern or complaint from a parent

how you would deal with a potential child protection issue, including allegations made against
yourself or a member of staff

what systems you will have in place to ensure all significant events and changes to your service are
promptly notified to CSSIW.
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Please provide copies of your:

complaints procedure (Regulation 32 and NMS 19.1)

child protection policy (Regulation 22 and NMS 20.2)
Inspector’s comment box
Signed
Date
08/2013
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Section Eight - The physical environment
Environment, equipment and safety
Relevant Regulations 20, 25, 37, 38
Outcomes
Linked NMS
21, 22 & 23

Children are cared for in an environment that is safe, secure and
suitable for their purpose

Children have access to furniture, equipment, toys and materials
that are appropriate and suitable for their needs

Children are cared for and have their needs met in a safe
environment.
You must

provide adequate space and access to all the necessary facilities for a range of activities which
promote children’s development

keep hazards for children to a minimum and ensure health and safety regulations are complied
with

ensure risk assessments in relation to the health and safety of the children are undertaken,
reviewed and available to parents and CSSIW

have an emergency evacuation procedure for the setting.
Please describe below how:

you will ensure that the premises are safe, secure, well maintained and suitable for its purpose

you will make the premises welcome to children

you will ensure that furniture, equipment and toys are well maintained and conform to BS EN
safety standards or relevant Toys (Safety) Regulations

you will ensure children are adequately supervised at all times (this includes trips away from the
premises).
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Please provide copies of your:

risk assessments

up-to-date safety certificates for gas/electrical/oil burning appliances (NMS 23.18)

statement of the procedure to be followed in the event of a fire or accident ( Regulation 30 and
Schedule 3, Paragraph 10 and NMS 5.1)
Inspector’s comment box
Signed
Date
08/2013
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Checklist of documents to be supplied with this application
Is the applicant also the person in charge
Yes
No
Schedule 2, Part 2, Paragraphs 38 - 46
In relation to an application made by an individual (in cases of more than one individual applicant
the following documentation must be supplied in relation to each of them):
Person to be registered and in day to day charge of the children
Tick here
Birth certificate
Proof of identity
A recent photograph
DBS application form for the person to be registered and anyone over the age of
16 who is living on the premises to be registered
Certificates or other suitable evidence relating to professional or technical
qualifications relevant to looking after children under the age of 8
A report by a registered medical practitioner as to physical and mental fitness to
look after children under the age of 8 or, if this is unobtainable, a statement by
the applicant as to the state of their physical and mental health
Signed and dated Social Services Department enquiry consent form for the
person to be registered and anyone over the age of 16 years who is living on the
premises to be registered
In relation to an application made by an organisation
Tick here
Birth certificate for the nominated ‘responsible individual’
Proof of identity
A recent photograph of the nominated ‘responsible individual’
DBS application form of nominated ‘responsible individual’ and anyone over the
age of 16 years who is living on the premises to be registered
A report by a registered medical practitioner as to whether the responsible
individual is physically and mentally fit to look after children under the age of 8
or, if this is unobtainable, a statement from the responsible individual as to the
state of their physical and mental health
Certificates or other suitable evidence relating to the relevant professional or
technical qualifications of the responsible individual
Copies of the organisation’s last two annual reports
If the organisation is a subsidiary of a holding company the last two annual
reports (if any) of the holding company and any other subsidiary of that holding
company
The last annual accounts of the organisation, if any
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In respect of the person in charge:
Tick here
Birth certificate
Proof of identity
DBS application form for the person in charge
A recent photograph
Certificates or other suitable evidence relating to the professional or technical
qualifications relevant to looking after children under the age of 8
A report by a registered medical practitioner as to whether the person in
charge is physically and mentally fit to look after children under the age of 8
or, if this is unobtainable, a statement from the person in charge as to the
state of their physical and mental health
Documentation required in respect of the premises:
Plan of premises
Certificate of Insurance in respect of liability which may be incurred in respect
of death, injury, public liability, damage or other loss occurring in relation to
the proposed provision of day care
Other documentation as requested in Part 2:
Statement of Purpose (Regulation 15 and NMS 1.2)
Your special needs policy (NMS 4.6)
Your confidentiality policy
Behaviour management policy (Regulation 23 and NMS 9.2)
Medication policy (NMS 11.5)
Lost/missing/not collected procedure (Regulation 30 and Schedule 3, Paragraph 13)
First aid certificates (Regulation 24(2)(b) and NMS 10.14)
Staff disciplinary procedure
Your equal opportunities policy (NMS 16.2)
Your operational plan (NMS 14.1 and 21.11)
Complaints procedure (Regulation 32 and NMS 19.1)
Child protection policy. (Regulation 22 and (NMS 20.2)
Risk assessment of the premises
Annual safety check for gas/electrical/oil burning appliances (NMS 23.18)
A statement of the procedure to be followed in the event of a fire or accident
(Regulation 30 and Schedule 3, Paragraph 10 and NMS 5.1)
Please note:
If the required documents are not submitted with the application, CSSIW will not accept the
application.
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Wherever possible, the applicant should bring their completed application form and all supporting
documentation to the local CSSIW office in person
Please remember to bring your completed Disclosure and Barring Service application forms. We
will also require a recent passport size, or larger, photograph which is a current true likeness. This
will be retained as part of your application.
You are advised to make a prior appointment for the purpose of lodging your application.
Section G: Declaration
The information I have provided in this application form and in any attached documents is, to the
best of my knowledge and belief, true and accurate. I understand that it is an offence to knowingly
make a statement in an application for registration which is false or misleading in a material
particular and to do so may lead to my/our prosecution and/or the refusal or subsequent
cancellation of my registration.
In making this application for registration under the provisions of the Children and Families
(Wales) Measure 2010 I agree to comply with the Child Minding and Day Care (Wales)
Regulations 2010 taking into account the National Minimum Standards for Regulated Child Care.
I agree to Care and Social Services Inspectorate Wales undertaking whatever checks it deems
necessary to verify my suitability:
This must be signed by all individual applicants.
An application made by an organisation must be signed by the responsible individual.
Signed
Date
Signed
Date
Signed
Date
When you have completed this form please contact CSSIW to make an appointment to submit
your application and present your documents for the DBS checks.
You are advised to keep a copy of this form for ongoing reference and guidance.
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Appendix 1 Medical reference
Medical reference for Care and Social Services Inspectorate
(Wales) in respect of a person applying to be a Child Minder or
Day Care provider
This section to be completed by the applicant:
Name and address
Postcode
Telephone number
Email
Date of birth
Place of birth
Maiden name
Any other surnames
This section to be completed by the applicant’s GP:
Name
Address
Post code
Telephone number
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Note to GP
Before completing the declaration below, please consider any existing medical condition for which the
applicant is being treated at the moment and any hospital admissions over the last five years which
may be relevant.
It is my opinion that after reading the medical
notes of
The applicant is physically and mentally fit to look after children under the age of 8
OR
The applicant has a condition or disability (including mental disability) which may
affect his/her ability to look after children under the age of 8
GP
Signature
Date
Surgery Stamp:
08/2013
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Appendix 2 Social Services consent form
Declaration and consent for CSSIW to contact Social Services Departments
Children and Families (Wales) Measure 2010 and the Child Minding and Day Care
(Disqualification) (Wales) Regulations 2010
A separate form must be completed by the applicant and all persons over 16 years who live at the
premises to be registered
Full name and address
Post code
Date of birth
Previous full addresses in the last five years:
Address
Address
Post code
Post code
From
Until
From
Address
Address
Post code
Post code
From
Until
From
Until
Until
Address
Post code
From
Until
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Have you ever been the subject of a care or supervision
order?
Yes
No
Have you had a care or supervision order made with
respect to a child in your care?
Yes
No
Have you ever been disqualified from fostering a child
privately?
Yes
No
If yes to any of the above, please provide details including dates and the Local Authority involved:
Please give the following details of children who currently live with you and of those who may now live
elsewhere:
Full name of child:
Date of birth:
dd/mm/yyyy
Relationship to you:
dd/mm/yyyy
dd/mm/yyyy
dd/mm/yyyy
dd/mm/yyyy
dd/mm/yyyy
Have you ever been disqualified from fostering children?
Yes
No
If yes, please give details including date of disqualification, reasons for disqualification and the local
authority involved.
I confirm that the information provided above is correct and I give my consent to Care and Social
Services Inspectorate Wales contacting my local or any relevant Social Services Department to be
satisfied I am not disqualified from registration to provide day care for children under the age of 8
years.
Name
Signature
Date
Please return this to your CSSIW office with your application forms.
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Appendix 3 Questionnaire to assess the suitability of the registered person
Questionnaire to assess the suitability of the registered person
The Children and Families (Wales) Measure 2010
A person must not act as a child minder or provide day care unless the person is suitable to look after
children under the age of 8. (Regulation 6(1) of the Child Minding and Day Care Regulations (Wales)
2010)
Care and Social Services Inspectorate Wales (CSSIW) must be confident that a person applying for
registration understands their role and responsibilities as a registered person for a day care service.
Where the applicant is an organisation this questionnaire should be completed by the nominated
responsible individual.
Please complete this questionnaire and submit with parts 1 and 2 of your application form.
Your application will be considered as a whole, and if necessary you may be called for an interview to
discuss any issues arising.
To help you complete this questionnaire you should refer to the following regulations:

The Child Minding and Day Care (Wales) Regulations 2010

The Disqualification from Caring for Children (Wales) Regulations 2010

The Child Minding and Day Care Exceptions (Wales) Order 2010
You will also need to be familiar with the National Minimum Standards for Regulated Child Care. You
can find these on our website: www.cssiw.org.uk
You may also want to contact your support organisation (Clybiau Plant Cymru Kids Clubs; National
Day Nurseries Association; Mudiad Ysgolion Meithrin; Wales Pre-school Playgroups Association).
Name of applicant
Address
Post code
Telephone number
Email address
Name of setting
Name of person in charge in the setting
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1. What experience and skills do you have which will help you in your role as a registered person?
(This may include any personal or professional experience, and does not have to be related solely
to child care.)
2. What do you understand your role and responsibilities to be as a registered person?
3. What is your understanding of the role and responsibilities of the person in charge in your day care
setting?
4. Tell us how the person in charge will be supported to enable them to receive opportunities for:

Training and professional development
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
Appraisal

Day to day management support
5. Which records must you keep about:

Children (refer to the Child Minding and Day Care (Wales) Regulations 2010; Regulation 30
and Schedule 3)

Health and Safety (refer to the Child Minding and Day Care (Wales) Regulations 2010,
Regulation 25)
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
Any staff you employ and volunteers (refer to the Child Minding and Day Care (Wales)
Regulations 2010, Regulation 28 and Schedule 1 and 2)
6. Tell us what changes and events you need to inform CSSIW about (refer to the Child Minding and
Day Care (Wales) Regulations 2010, Regulations 10, 15, 23 and 31 and Schedule 4)
7. How will you ensure that the provision operates smoothly and meets its objectives with reference to
the statement of purpose, staffing, policies and procedures?
8. How will you establish, monitor and maintain the quality of your service? (refer to the Child Minding
and Day Care (Wales) Regulations 2010, Regulation 16)
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9. How do you intend to keep your knowledge and understanding of day care up-to-date?
Thank you for completing this questionnaire. It will help us to assess your application. When your
application has been considered, you will be contacted by an inspector who will let you know if there is
anything more you must do.
Please read and sign the following declaration:
If my application to be a registered person is successful, I understand that I am legally responsible for
the continued registration of the setting until I have informed CSSIW in writing and notified any other
registered person of the date I shall cease to be the registered person.
I understand that if there are no registered persons, the setting cannot remain registered by CSSIW.
Signature of proposed registered person:
Date:
08/2013
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