Registration – Happy Kids Nursery & Education Centre

Child Name:(Required)

First Last

Date of birth:(Required)

Sex:(Required)

Religion(Required)

Religion (or N/A):

Language(Required)

Language(s) spoken or understood:

Address(Required)

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(Required)

Yes

No

Yes or special access requirements (give details):

Disability Details(Required)

Allergies(Required)

Yes

No

Any allergies or other medical conditions (give details)?

Allergies Details(Required)

Is immunization schedule up to date?(Required)

Yes

No

History of illnesses:(Required)

Special Educational Needs(Required)

e.g. My Plans, EHCP or any other education, health and care plan. Please give details or write "None".

Any concerns(Required)

e.g. communication and language, physical, sensory, neurodivergent etc. Please give details or write "None".

Previous nursery / setting / childminder(Required)

Name of any previous nursery, setting or childminder. Please give details or write "None".

GP (family doctor)(Required)

Name, address, telephone:

Any other professionals involved with your family(Required)

e.g. speech and language therapist, occupational therapist, physiotherapist, social worker, paediatrician etc. Please give details or write "None".

Child’s health visitor:(Required)

Name, address, telephone:

Toilet requirements:(Required)

Special dietary requirements:(Required)

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

Yes

No

May we photograph your child when in a group?(Required)

Yes

No

For internal use only.

May we give Calpol for high temperature?(Required)

Yes

No

Name of person(s) with parental responsibility:(Required)

First Name

Last Name

Parents NIN :

Parents DOB:

Home address (if different from above):(Required)

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

Email:(Required)

Work address:(Required)

Work telephone:(Required)

Emergency contact(s):(Required)

Name

Relationship to child

Telephone

People authorized to pick up child:(Required)

Name

Relationship to child

Telephone

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

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