Nursery Registration and Consent Form | Filthy Squirrels Woodland Nursery

Child's name

Address

Child’s ethnic origin

Date of Birth

Gender

Child’s spoken language

Other languages spoken

Desired Start Date

Birth Certificate/Passport Number

*For funding purposes, Wiltshire require us to see either a birth certificate or passport for proof of entitlement. You will be required to show these to a staff member prior to funding starting.

Name of parent or guardian (Main contact)

Email Address

Contact Number

Relationship to child

Address

Same as child

different

Address if different

Second Contact Name

Email Address

Contact Number

Relationship to child

Address

Same as child

different

Address if different

Places requested

Length of contract

Term time only

All year round

Please indicate how many hours you would like to use at Filthy Squirrels.

In some cases, your child may be entitled to Early Years Pupil Premium. This is extra funding that should be used in the setting to support the education of your child. In order for a child to be eligible for Early Years Pupil Premium, they must be accessing three and four year old free entitlement hours as well as meet one or more of the following criteria:
• Income Support
• Job Seeker's Allowance (income-based)
• Employment and Support Allowance (income-related)
• Support under part six of the Immigration and Asylum Act 1999
• The guarantee element of State Pension Credit
• Child Tax Credit - providing you are not entitled to Working Tax Credit and your family's annual income (as assessed by HMRC) is not more than £16,190
• Working Tax Credit 'run-on' - the payment you may receive for a further four weeks after you stop qualifying for Working Tax Credit
• The child has been looked after by the Local Authority for at least one day
• The child has been adopted from care, is the subject to a special guardianship order, or are subject to a child arrangement order setting out whom the child is to live with

If you think you qualify for Early Years Pupil Premium, please tick this box.

30 Hour Code

Parent National Insurance Number:

Parent Date of Birth

You may split these hours between Filthy Squirrels and one other setting if agreeable with the other nursery in question.

I would like to split the funding:

Other Nursery including address:

I declare my child physically fit to participate at Filthy Squirrels Woodland Nursery activities. I understand that there is an element of risk and I accept that. In the case of an incident, I give permission for First Aiders to treat my child. In the event of any change I will inform Filthy Squirrels.

Yes, I give my permission

No I don't give permission

I accept that personal belongings are not covered by Filthy Squirrels insurance and that Filthy Squirrels will not be held responsible for damage to, or loss of these items.

I accept

Photos and videos are taken during our sessions. These are used for assessing, evaluation and monitoring processes. At times, they may also be used in our marketing, publicity and website including social media. I give permission for these photos to be used in marketing and social media.

I give my permission

I don't give my permission

The information on this form is covered by the ICO and will be entered onto our computer for the purpose of Filthy Squirrels Administration only.

Name

Date

I consent to my personal email being added to the Filthy Squirrels Mailing List. This will be used to provide you with information. At no time will your email be given, sold or passed to a 3rd party without consent.

I consent

The Threshing Barn, Unit 8,

Fifield Bavant,

Wiltshire, SP5 5HT