Nursery Registration and Consent Form | Filthy Squirrels Woodland Nursery

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Home
The Filthy Squirrel Way
Join the Filthy Squirrel Family
- Nursery Registration and Consent Form
- Waiting List
Camp Squirrel
- Holiday club registration form
Policies

Nursery registration and consent form

Child's Name*

Date of Birth*

Address*

Gender*

Child's Spoken Language

Other languages spoken

Child’s ethnic origin

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)*

Second Contact Name*

Email Address*

Email Address*

Contact Number*

Contact Number*

Relationship to child*

Relationship to child*

Address*

Same as child Different

Address

Same as child Different

Address if different

Doctors Name*

Surgery Phone Number*

Surgery address

Is the child up to date with their immunisations?

Yes No

Does the child have any medication conditions, disabilities, additional support needs or receive regular medication?

Yes No

If yes, please give details.

Do you give Filthy Squirrels consent to share information about your child with other agencies including Speech and Language Team, Health Visitor, Social Worker, other settings that your child attends?

Yes No

*Filthy Squirrels have the right to share information about the child to the appropriate professionals without consent if we are concerned about the welfare of the child.

Other please list

Are there any professionals currently involved with your child?

Health Visitor Social Worker Speech Therapist Other

Desired Start Date

Places requested

Term time only All year round

Monday

8:30 - 9:00am 9:00 - 3:00pm* 3:00 - 4:00pm 4:00 - 5:00pm

Tuesday

8:30 - 9:00am 9:00 - 3:00pm* 3:00 - 4:00pm 4:00 - 5:00pm

Wednesday

8:30 - 9:00am 9:00 - 3:00pm* 3:00 - 4:00pm 4:00 - 5:00pm

Thursday

8:30 - 9:00am 9:00 - 3:00pm* 3:00 - 4:00pm 4:00 - 5:00pm

Friday

8:30 - 9:00am 9:00 - 3:00pm* 3:00 - 4:00pm 4:00 - 5:00pm

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.

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

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.*

Yes, I give my permission No, I don't give permission.

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.*

Yes, I give my permission No, I don't give 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.

Parent Signature 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. Find all of our policies here *

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

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Email Address

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