Registration – Happy Kids Nursery & Education Centre

Child Name:(Required)

First Last

Date of birth:(Required)

Sex:(Required)

Religion

Religion (or N/A):

Language

Language(s) spoken or understood:

Address

Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country

Telephone number:(Required)

Email(Required)

Enter Email Confirm Email

Photo:

Max. file size: 128 MB.

Disability

Yes

No

Yes or special access requirements (give details):

Disability Details

Allergies

Yes

No

Any allergies or other medical conditions (give details)?

Allergies Details

Is immunization schedule up to date?

Yes

No

History of illnesses:

GP (family doctor)

Name, address, telephone:

Child’s health visitor:

Name, address, telephone:

Toilet requirements:

Special dietary requirements:

Do you give permission for your child to go on daily outings?

Yes

No

May we photograph your child when in a group?

Yes

No

For internal use only.

May we give Calpol for high temperature?

Yes

No

Name of person(s) with parental responsibility:

First Name

Last Name

Parents NIN :

Parents DOB:

Home address (if different from above):

Home or mobile telephone or both (if different from above):

Email:

Work address:

Work telephone:

Emergency contact(s):

Name

Relationship to child

Telephone

People authorized to pick up child:

Name

Relationship to child

Telephone

Password for pick up by anyone not named above (BLOCK LETTERS PLEASE). This will be kept confidential:

I give my consent for my child to receive any medical treatment which is urgently necessary.(Required)

Yes

No

The Happy Kids – Education Centre has a commitment to safeguarding children and promoting their welfare. Any staffs who suspect that a child in their care is suffering any type of abuse has a duty to report this to Social Services.(Required)

I am aware of and understand the statement above.

Registration Form