Updated April 2017 Forget me Not
Private Day Nursery
ENROLMENT FORM & CONTRACT
This contract is between Forget Me Not Private Day Nursery, 9 Parkdale Road, Bakersfield, Nottingham, NG3 7GL
- Parent /Guardian Details
D.O.B: -
Relationship to child: -
Address: -
Contact Telephone
Numbers / Home: -
Work: -
Mobile: -
Occupation and address of work
Email Address
National Insurance No
- Parent /Guardian Details
D.O.B: -
Relationship to child: -
Address : -
Contact Telephone
Numbers / Home: -
Work: -
Mobile: -
Occupation and Work Address
Email Address
National Insurance No
Parent Responsibility
The Early Years Foundation Stage Framework Statutory Requirement ‘Safeguarding and Promoting Children’s Welfare states that childcare providers must obtain ‘information about who has legal contact with the child and who has parental responsibility.’
Therefore, could you please complete the details requested below, prior to your child being admitted into our care. If there are any subsequent changes to these details please let a member of Management at Forget Me Not Private Day Nursery know immediately.
Child’s Details / Child’s Full Birth Name: -Child’s Date of Birth: -
Child’s Ethnicity: -
Address : -
Parent/ Carer 1 / Name: -
Relationship: -
Legal Contact: - Yes [ ] No [ ] n/a [ ]
Parental Responsibility: - Yes [ ] No [ ]
Parent/Carer 2 / Name: -
Relationship: -
Legal Contact: - Yes [ ] No [ ] n/a [ ]
Parent Responsibility: - Yes [ ] No [ ]
Parent/Carer 3 / Name: -
Relationship: -
Legal Contact: - Yes [ ] No [ ] n/a [ ]
Parent Responsibility: - Yes [ ] No [ ] n/a
Third Contact Details / Name: -
Address: -
Relationship: -
Contact Numbers: -
Child’s Doctor’s Details / Name: -
Address: -
Telephone: -
Child’s Medical History
Immunisations / Polio Tetanus Diptheria
Whooping Cough MMR
Any special diet due to health, religious or cultural reasons
Required Start Date
Please note that full fees will be required from the above date
Place required for full days / Monday Tuesday Wednesday Thursday Friday
Place required for mornings / Monday Tuesday Wednesday
Thursday Friday
Place required for afternoons / Monday Tuesday Wednesday
Thursday Friday
Parent Consent
I agree for photographs of my child to be displayed around the nursery on display
Signed: ______
I agree for photographs of my child to be used on the nursery community private Facebook page
Signed: ______
I agree for my child to take part in outings with the nursery such as the local park, shops and visiting the local community
Signed: ______
I understand that full fees must be paid to the nursery 50 weeks of the year including Bank Holidays. I understand that the nursery must be given one months written notice if my child’s place is no longer required or I will pay one months fees in lieu of notice. Cheques are not accepted ,
Signed :______
I agree to my child being seen by a doctor in an emergency.
Signed :______
I agree my child may be given Calpol by nursery staff if they feel immediate steps should be taken to lower my child’s temperature.
Signed :______
I agree that I will have to pay a fee if my child is not collected on time.
Signed :______
I agree to comply with the nursery’s equal opportunities policy.
Signed :______
I have read the nursery prospectus and agree to comply with nursery regulations.
Signed :______
I understand that the nursery has a right to ask a child to leave if it becomes necessary
Signed :______
I understand that the nursery is under an obligation if it is felt that my child’s welfare is in danger to inform Social Services.
Signed by: - Date: -
Office Use only
All areas filled in correctly [ ]
Start Date arranged with visits [ ]
Nursery Fee payment arranged [ ] signed:- Date:-
Signed :______