NORTHLEACH PLAYGROUP

Mill End, Northleach, Cheltenham, Gloucestershire, GL54 3HJ

Registered Charity No. 1015852

 

                             Registration Form

 

Children must be between 2 years 6 months and 5 years of age to attend.  Some parents prefer their child to start slightly later, i.e. when they turn 3 years old.  Please state your preferred start date below.

 

All parents are expected to contribute to the running of the group by administering the financial and fund-raising aspects, plus helping at the playgroup on a voluntary rota basis once your child is settled.  These are both organised by the playgroup management committee.

We offer a minimum of two sessions per week and preference is given to children intending to attend full-time and who are not attending any other pre-school provision.

Child’s full name: ……………………………………………………………………..……………..

Date of birth: ………………………………………………………………………………………....

Sessions required (please tick):

Day

Morning session

Afternoon session

 

Monday

 

 

 

Tuesday

 

 

 

Wednesday

 

 

 

Thursday

 

 

 

 

 

 

 

Friday

 

 

Pre-school children only

Preferred start date: ……………………………………………………………………………….

Parent contact name: ……………………………….……………………………..……………..

Day time telephone number: ………………………………………………………………….

Details of other setting/s child attends

Name of setting: ……………………………………………………………………………………..

Contact details: ……….…………….……………………………………………………………....

Child’s key point of contact: …………………………………………………………………….

Permission to contact the above:        Yes/No

Thank you for completing this form.

Please return to Northleach Playgroup, Mill End, Northleach, Gloucestershire, GL54 3HJ northleach_playgroup@yahoo.co.uk

Medical/Contact Form

 

1.          Child’s full name : ………..……………………………………………………..……………..................................

2.          Date of birth:…………….…...........Age: ……………………………… M/F: ………………

3.          Address of child : ………………………………….…………………………………………….............................

…….…………………………………………………………………………………………………

………………………………………………… Postcode: …………………………………………

4.          Parent (s) full name : ……………………………………………………………..……………...................................

…………………………………………………………………………………………………………

5.          Address (if different from child’s):

….…………….………………………………………….................................

…………………………………………………………………………………………………………

…………………………………… Postcode: …………………………………………

6.          Contact details:

Home: ……………………………………............ Work tel: …………….…………………

Mobile tel: …………………………………........ Other: ………………………………………

Email Address………………………………………………………………………………..

7.          Other family members:

Name:  …………………………………………………….……….............. Age: ………...…

Relationship: …………………………………………………………………………………

Name:  …………………………………………………….……….............. Age: ………...…

Relationship: ……………………………………………………………………………

Name:  …………………………………………………….……….............. Age: ………..

Relationship: …………………………………………………………………………

Name:  …………………………………………………….……….............. Age: ………...…

Relationship: …………………………………………………………………………

8.          Name and address of doctor:  …………………………………………….………………...............................

………………………………………………………………………………...………..………

9.          Health visitor: …………………………………………………………………………………….......................

10.   Details of allergies, e.g. plasters, dairy products, etc: …………………………………........................………………………………………………………………………………….……..……………………………………………………….

11.   Details of any medical conditions which the staff may need to know about, e.g. Fits, speech defects, travel sickness (for outings):

………………………………………….………………………………………………………...

….……………………………………….………………………………………………………

12.   Any dietary requirements:

……………………………………………………………….....................................

………………………………………………………………………………………………...............

13.   Does your child have any specific cultural requirements:……………………………..........................……………………………………….……………………………………………………………........................................

14.   Special word/phrase for going to the toilet: …………………………………………...............................

15.   Emergency contacts (please provide two if possible):

Name:……………………………………………….……………….……...……………………

Address:……………………………………………………………………………..…………..

………………………………………………………………………………..…………………..

Relationship to child: ……………………………..Tel:…………..…………………………...............................

Name:  ………………………………………….……………….……...………………………..............

Address: …………………………………………………………………………………….......................

……………………………………………………………………………………………………

Relationship to child: ……………………………..Tel:………..…………………...................

16.   Childminder’s name, address and telephone number (if applicable):

Name:  …………………………………………………….……………….……...……………..............

Address…………………………………………………………………………………………..

…………..………………………………………………………………………………………

7.   Names and descriptions of any other persons whom you have authorised to collect your child.  Please tell the person in charge of any additional special or changed arrangements you may have to make on any specific day.

…………………………………………………………………………………………………………………………………………………………………………………………………………

……………………………………………………………………………………………………

Signed:  ………………………………………………………….……………….… Parent/Carer

Signed: ………………………………………………………….……………….… Parent/Carer

Date:  ……………………………………………...................................

 

Checked by: ………………………………………………………………….....

Position: ………………………………………………………………………….…

Date: …………………………………………………………………………………

 

 

 

 

 

 

 

Thank you for completing this form.

Please return to Northleach Playgroup, Mill End, Northleach, Gloucestershire, GL54 3HJ

Northleach_playgroup@yahoo.co.uk