ADMISSION FORM FOR WINYATES PLAYGROUP
To be completed in pen or typed by the parent and handed to the supervisor
CHILD’S NAME ¼¼¼¼¼¼¼¼¼¼¼¼¼………………¼ DATE OF BIRTH ¼¼¼¼¼¼
HOME ADDRESS ¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼Post code ¼¼¼¼¼
MOTHER’S NAME ¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼ Tel No. ¼¼¼¼¼¼¼
MOTHER’S CONTACT ADDRESS ¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼
FATHER’S NAME ¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼ Tel No. ¼¼¼¼¼¼¼
FATHER’S CONTACT ADDRESS ¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼
WHO & WHERE TO CONTACT IN AN EMERGENCY ¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼…………………
NAME OF PERSON WHO WILL COLLECT CHILD ¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼
NAME OF PERSON OR BODY LEGALLY RESPONSIBLE FOR THE CHILD ¼¼¼¼¼¼¼¼……………
CHILD’S DOCTOR ¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼ Tel No. ¼¼¼¼¼¼¼
IMMUNISATION / VACCINATIONS ¼¼¼¼¼¼¼¼¼¼¼¼……………………¼¼ Meningitis (Y/N)?¼¼¼¼¼¼¼¼
INFECTIOUS ILLNESSES ¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼
HEALTH VIS1TOR ¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼
ANY SPECIAL DIET, CULTURAL REQUIREMENTS, ALLERGIES, HEALTH PROBLEMS ETC.
ANYTHING ELSE THE GROUP SHOULD KNOW ABOUT YOUR CHILD
1. I agree to my child being taken to hospital or to being seen by the nearest Doctor available should an emergency rise.
2. I understand that my child will not be admitted to the playgroup if he/she is not well (including head lice) and no sooner than 48hrs after vomiting.
3. I agree to my child being taken out on an organised pre-school group trip, such as a local walk.
4. My child does/does not attend another pre-school group
5. My child will be attending ¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼ 1st School
6. I understand the Playgroup operates in accordance with its published Prospectus and Policies and that copies are available to me on request.
7. I agree to my child being included on Playgroup photographs which may be used for evidence of activities for OFSTED and be published on the Playgroup website.
8. We are promoting health foods such as fruit and vegetables. Therefore, I understand my child will be given the opportunity to try new foods and tastes and I will inform a member of staff of any allergies that might arise, immediately.
Signed ¼¼¼¼¼¼¼¼ Name ¼¼¼¼¼¼¼¼ Date ¼¼¼¼¼¼¼¼
Enrollment Date (Playgroup supervisor) ¼¼¼¼¼¼¼¼¼
Winyates Playgroup Ltd, Unit 11 Winyates Centre, Redditch. B98 0NR.