ALPHABET HOUSE

Day Nursery and Pre-School

444,Fleetwood Road.Fleetwood. FY7 8AT

Tel: 01253 878600

ENROLMENT FORM

Name of Child ………………………………………………………...Date of Birth ………………...

Address……………………………………………….…………………Postcode…………………….

Tel No …………………………………………………

Parents Names ………………………………………………………………………………………….

Please provide the name/names of the person/ persons who have legal parental responsibility of the enrolled child.

  1. …………………………………………….. 2. ………………………………………………...

Please provide any additional addresses that the child usually resides at.

……………………………………………………………………………Postcode……………………

Tel No: ……………………………………………..

Contact details:

Mother ………………………………………………HomeTel …….……………………………......

Work Tel ……………………………………………Mobile Tel ……………………………………...

Father ……………………………………………….. Home Tel ……………………………………..

Work …………………………………………………Mobile Tel …………………………………….

Who would you like us to contact in an Emergency:

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

Any other additional contact numbers you would like to provide

Name ……………………………………………….Tel ………………………………………………

Name ……………………………………………….Tel ………………………………………………

Childs Doctor ……………………………………………………Tel………………………………….

Childs Health Visitor ……………………………………………Tel………………………………….

Details of Immunisations ……………………………………………………………………………….

Is your child on any short/ long term medication? (Give Details) ……………………………………..

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Please give details of any allergies, conditions or illnesses that your child has……………………….

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Please give details of any special dietary needs of your child …………………………………………

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Is there anything else that we need to know about your child such as: Does he/she attend/ access or is involved with any other agencies ie Speech and language therapy, Occupational therapist, Physiotherapy department, Portage, Developmental classes, Sure Start? ……………………………...

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

What Nationality is your child? ………………………………………………………………………...

What is your child’s first language? ……………………………………………………………………

Does your child have any religious and/ or cultural needs or practices? ………………………………

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

Are you registered with your local Children’s Centre? …………………………………………......

Which Children’s Centre are you registered with? ……………………………………………......

If you are not registered with your local Children’s Centre and wish to be, please complete the registration card included within this pack.

Do you wish your child to attend full or part time?

If part time please tick the appropriate boxes.

Morning Afternoon All Day

Monday
Tuesday
Wednesday
Thursday
Friday

Date to Start ……………...... Actual Start Date ………………………………….

I wish to apply for admission to Alphabet House Day Nursery. I confirm that I have read the nursery information sheet and policies and agree to abide by the terms and conditions of the Nursery. Fees are to be paid one week in advance. You may pay weekly or monthly but must be a minimum of one week in advance at all times. If payment is missed for any reason eg sickness, we will allow you to pay on the first session your child attends – failure to pay fees on this day will result in your child being unable to attend on their next and subsequent sessions and possible loss of their place completely.

Payments may be made by Cash and credit or debit card. (We can no longer accept cheques as the banks do not guarantee them.)We can also accept card payments over the phone if your child is dropped off and collected by other carers. We can also take payments by BACS and Standing Order, which can be made weekly or four weekly. Please ask for a standing order mandate.

We do not ask for a bond, however if you require a place to be held available for more than two weeks we would ask for the first weeks fees in advance as your commitment to take up the place. This would be non-refundable if you do not take up the place.

I agree to give two weeks’ notice to terminate my child’s place.

I also give/do notgive my consent for Alphabet House to share information with other agencies and professionals in relation to their progress and educational development

To comply with the new General Data Protection Regulations which come into force on 25th May 2018 we have set out our Privacy Policy on our website .We will only use your personal information in relation to our childcare service. We will only advise you via our monthly newsletter or by letter of any information regarding your child and the nursery. We keep your information secure and will never share it except if required to do so by law.

By signing this agreement,you are also consenting to us continuing to holding and processing your data and sending you information as according to our Privacy Policy

Signature of Parent ………………………………………Date ………………………………………..

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Alphabet House