1. Bay-B-Care Lynsey Johnson – registered childminder ref no EY423464 Registration Form Your details Name of parent(s)/guardian(s)......................................................................................................................................................... Address...................................................................................................................................................................................................................................................................................................................................................................................................... Contact telephone numbers....................................................... Home........................................................................ Mobile Your child’s details Name................................................................................................................................................................................................ Date of birth / / Doctor........................................................................... Tel........................................................ Childcare requirements Days (please circle) Mon Tue Wed Thu Fri Times............................................................................................................................................................................................. Any dietary requirements/allergies

2. Registration Form Emergency contact details Name................................................................................................................................................................................................ Contact telephone numbers....................................................... Home........................................................................ Mobile Name................................................................................................................................................................................................ Contact telephone numbers....................................................... Home........................................................................ Mobile Person(s) authorised to collect child Name..................................................................................... Relationship to child................................................................. Contact telephone numbers....................................................... Home........................................................................ Mobile Name..................................................................................... Relationship to child................................................................. Contact telephone numbers....................................................... Home........................................................................ Mobile Name..................................................................................... Relationship to child................................................................. Contact telephone numbers....................................................... Home........................................................................ Mobile Please detail any special needs, medical conditions and medication instructions, cultural or ethnical requirements below: Signature(s) Signature........................................................ Print name.................................................................. Date / /