1. Registration Form
Child’s Full Name Date Of Birth Home Address
Parent / Guardian’s Name
Employer:
Work Address:
Tel Home
Tel Mobile
Tel Work
Home address if different from above:
Other Contact Details
Name
Address
Tel
Other authorised Persons to collect.
Password
How did you hear about the Nursery?
Start Date Required:……………………………….
Mon Tues Wed Thurs Fri Nursery Tea? Y / N
AM PM AM PM AM PM AM PM AM PM Nursery Lunch? Y / N
Session Details (circle both for all day)
GP Details:
Please state details of
Allergies
Special Needs
Dietary Requirements
Can Orchard Trees Day Nursery seek help/advise in an medical emergency.
Yes / No
Can your child being taken on outings
Can treatment be administered eg teething gel, calpol, plasters for cuts + grazes
Can sun cream be applied? Can your child’s face be “painted”?
Sun Cream Y/N Face Painting Y/N
Can Photographs be used for Internal displays
Can Photographs be used for marketing material including Orchard Trees Web Site
Can Photographs be used for Local Newspapers
Can your child be named in photographs as above
I have read and understood the Nursery Procedures, Terms and Conditions.
I have enclosed a copy of my child’s Birth Certificate.
I enclose a Non Refundable payment for the Registration Fee of £25.00 payable to Orchard Trees Childcare Ltd.
Monthly Fees will be paid by Standing Order / Internet Banking / Cheque / Vouchers provided by……………………
Parent / Guardian Signature Date
Manager Signature Date
Registration Fee Received? Y/N Cash/Cheque Amount Date
Confirmation Letter Sent Date
Terms and Conditions signed by parent and returned Date Birth Certificate Received Date
Orchard Trees Day Nursery, The Old Wood Yard, Main Street, Thorganby, York, YO19 6DE
Tel
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