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

ADDRESS                                     ¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼

IMMUNISATION / VACCINATIONS                          ¼¼¼¼¼¼¼¼¼¼¼¼……………………¼¼ Meningitis (Y/N)?¼¼¼¼¼¼¼¼

INFECTIOUS ILLNESSES        ¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼

HEALTH VIS1TOR                    ¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼

ANY SPECIAL DIET, CULTURAL REQUIREMENTS, ALLERGIES, HEALTH PROBLEMS ETC.

¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼

ANYTHING ELSE THE GROUP SHOULD KNOW ABOUT YOUR CHILD

¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼

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.