Nursery Registration Form

Noah’s Ark Day Nursery
Registration Form
Start Date:
Settling Date:
Child’s name:__________________________________ EDD/Date of Birth: ___/___/____
Gender: Girl
Religion:_______________________ Ethnic Origin:________________
Boy
Unk
Parent/Family Details
Mothers Name: _________________________ Fathers Name: _________________________
Address: ______________________________ Address (if different):_____________________
______________________________________ ______________________________________
______________________________________ ______________________________________
___________________Post Code:__________ ____________________Post Code:_________
Tel Home:___________ Work:_____________ Tel Home:___________ Work:_____________
Mobile or other: _________________________ Mobile or other: _________________________
Email address: _________________________ Email Address: _________________________
Employers Name & Address: ______________ Employers Name & Address: ______________
_____________________________________
______________________________________
_____________________________________
______________________________________
___________________Post Code:__________ ____________________Post Code:_________
Which parent/carer has full guardianship/custody of the child? Both/Joint Mother Father
(If required we may ask for prove, by way of birth certificate and/or court documents.)
Name & Telephone number of an appropriate adult who may be contacted in time of emergency
if you are not available: ______________________________ Relationship to child: __________
Name and Address of other carers not already mentioned: ______________________________
_____________________________________________________________________________
_____________________________________________________________________________
Please give details of any other children in the family, and their dates of birth:
Name
Date of birth
Gender
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
Page 1 of 3
Medical Details:
Doctor’s Name and Address: ____________________________________________________________
___________________________________________________________________________________
_______________________________________________Tel No:______________________________
Health Visitor: ___________________________________ Tel No: _____________________________
Are all immunisations up to date? Yes No . If no, state exceptions: __________________________
___________________________________________________________________________________
Has your child had Chicken Pox? Yes No
Don’t Know
Any special medical notes/allergies/special dietary requirements/ other medical requirements?
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
Please detail any special needs or other information we may need to care effectively for your child?
Failure to inform us of specific known needs may delay your child’s future development and the help we
can give them.
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
What sessions would you like? Start Date: ____________________
Morning
Afternoon
Full Day
Monday
Tuesday
Wednesday
Thursday
Friday
Do you wish to go on the Waiting List if we cannot meet your immediate requirement? Yes:
No:
Does your child attend any other Early Years settings, including nursery, pre-school, playgroup,
child-minder etc? ___________________________________________________________
_________________________________________________________________________
______________________________________________________ (see Terms and Condtions paragraph 2.5)
Email details:
We would like to reduce paperwork and contact parents/carers via email as much as possible. Please
tick the following, if you would like to receive emails:
Receive Invoices/Billing Reminders
Receive Newsletters
Where did you hear about us? (please tick)
Sibling already attends
Newspaper Advert
Yellow Pages
Other Advert
Website
Promotional Leaflet
Word of Mouth/ Recommendation
Children’s Information Service
Other (please state): ______________________
Page 2 of 3
Nursery Terms and Conditions
1. Definitions:
1.1 The definitions below apply in these terms and conditions:
“Child” the child who is named at the top of this form
“You” the parents/carers completing the form
“Us” Noah’s Ark Day Nurseries Ltd
“Services” the services provided by Us during the days or half days,
or otherwise booked, together with any other services which we provide,
or agree to provide, to you
2. Registration Details and Records:
2.1 You confirm that to the best of your knowledge the information provided in this form is accurate, and that You will inform Us of any changes to it, including any changes in parent/carer status, any family circumstances or court orders which might affect the Child’s welfare or happiness and changes in attendance at other early years settings.
2.2 You agree to pay a non-refundable registration fee of £50, with this
form. This includes two 2 hour settling in visits to the nursery. This secures your nursery place and covers administration costs.
2.3 Where possible, sessions will be made available to meet your needs
subject to the requirements on this form, however, you should confirm
with Us that the sessions are available prior to completion of the form.
2.4 You understand that your child’s records will be held on a computerised database and that this is kept in accordance with the Data Protection Act 1998, and that they will be used for no other purposes than
Nursery Business, and will never be passed onto third parties. You also
agree to this form, and any others, related to the child, being kept by Us
for the period of time the child attends the Nursery and a further 7
years—this is for public liability reasons.
2.5 Noah’s Ark uses a variety of communication methods, including
telephone, email and SMS—You therefore agree for us to use these
methods in line with our normal procedures. A copy of these are available in the nursery.
2.5 You agree that Noah’s Ark may contact any other early years settings your child attends, to discuss the development and learning progress of your child, as is recommended good practice in the Early Years
Foundation Stage guidance.
NB: A separate ‘Photograph/Video’ form is provided detailing the Nursery’s policy on photographs and videos/dvd’s taken in the nursery or at
nursery events.
3. Nursery Fees:
3.1 Nursery invoices will be raised on at least a monthly basis. Payment should be made within 5 working days of receipt of the invoice.
Standing orders must be processed on the 1st day of every month. A
full explanation of the billing process will be provided at your child’s
settling session.
3.2 Without restricting any other legal right that we may have, if you fail
to pay us on time, we may:
3.2.1 Charge interest on the overdue sum from the due date for the
payment at the annual rate of [7]% above the base lending rate from
time to time of [full name of your bank], accruing on a daily basis and
being compounded quarterly until payment is made, whether before or
after any judgement is obtained, and you shall pay the interest immediately on demand.
3.2.2 Charge you a reasonable administration fee (currently £20); and
3.2.3 Suspend all Services until payment has been made in full, which
will include the suspension of the Child, or even terminate the contract
permanently.
3.2.4 If you are 60 days or more late in paying us, we may also charge
you our reasonable costs of seeking to recover the overdue payments.
Such costs will be added to your running account and should be paid
within 30 days of notification of them to you.
3.2.5 If you owe us any money, and make a claim against us, we may
set off what you owe us against what you are claiming from us.
3.3 You agree to pay a late collection fee, as laid out in the latest nursery fees list, if my/our child is collected late from the nursery.
3.4 You agree to reimburse any bank charges incurred due to cheques
being returned unpaid and to pay any and all legal costs for recovery of
outstanding monies.
3.5 You understand that fees are due in cases of illness or other absences from Nursery with the exception of Bank Holidays and any
planned Nursery closure (e.g between Christmas and New Year).
3.6 You agree to give a minimum of one month’s notice in writing to the
Us, or one month’s fees in lieu of notice, if, for any reason your child
has to leave the Nursery.
4. Duty of Care/Illness:
4.1 In the event of emergency treatment being necessary, You agree to
your child being taken directly to hospital, or being seen by the nearest
doctor.
4.2 You understand that your child will not be admitted to nursery if
she/he is unwell, and You will keep them out of nursery as required,
according to the exclusion periods as laid out by Noah’s Ark Day Nurseries Ltd. These periods are displayed in the Nursery and copies are
provided individually to parents.
4.3 You also agree to collect your child if they become ill whilst at the
nursery. This will also apply if a single temperature reading of 38oC
(100.4oF) or higher is taken, and is irrespective of whether the child is
on Infant Paracetamol. This follows the guidelines given by NHS Direct.
This stands for all cases, except where the child has been immunised in
the previous 48 hours—in which case, you will be contacted and consulted by the nursery staff. See exclusion sheet.
4.4 You understand that the nursery is only able to administer prescribed medicines or teething gel and nappy rash cream (e.g. Sudocream). You understand that the nursery staff are not able to administer any other medicines.
4.5 In the event of your child requiring medication, as laid out above,
You shall complete a Medication Form consenting to the nursery staff
administering the child’s medication as instructed by myself/ourselves,
in accordance with the prescription. Medication will be given by a Room
or Deputy Room Leader, and a further witness will be present. Parents
must sign this form prior to medication been given.
4.6 You understand that in the event of your child being prescribed
antibiotics, that your child will not be allowed into nursery for a period of
48 hours after their first dosage. This is to ensure that the risk of sideeffects has already been eliminated. If a child is on antibiotics more than
once for the same type of medication then they may be let into nursery
after 24 hours but only if it is the same antibiotic.
4.7 Infant Paracetamol (i.e. Calpol) – Infant Paracetamol can be very
effective at reducing children’s temperature, it is, however, but may
mask symptoms when there could be something more seriously wrong
with a child. Because of this it is nursery policy not to administer Infant
Paracetamol. The nursery will only administer Infant Paracetamol to
treat the specific problem for which it has been prescribed. Please refer
to exclusion listed provided.
4.8 You agree to the use of individually wrapped sterile adhesives
(plasters) unless You have already indicated that the child has allergy to
these.
5. Pets
5.1 You agree (unless you specify otherwise) that your child may come
into contact with the nursery pets. This may include handling, feeding
and caring for them.
6. Outings
6.1 You agree to your child going on nursery outings and understand
the children will always be accompanied by the required OFSTED ratio
of staff.
6.2 In the event of an outing involving travel, in either Nursery approved
vehicles or public transport, I/We will be required to sign a Consent
Form for that outing/trip. Car Seats will comply with the new regulations
of September 2006.
7. Personal Belongings:
7.1 You agree that no responsibility will be held for any loss or damage
to my/our child’s property. Every reasonable effort will be made by the
Nursery and its staff to ensure the children’s belongings are not lost or
damaged.
8. This Agreement:
8.1 These terms and conditions represent the entire agreement and
understanding between You and Us. Any other understandings, agreements, warranties, conditions, terms or representations, whether verbal
or written, expressed or implied are excluded to the fullest extent, permitted by law.
8.2 You understand that the nursery has the right to update or amend
these Terms and Conditions at anytime. One calendar month’s notice
will be given of any changes at nursery.
Signed: ______________________________________________ Date: ___ / ___ / ___
(Mother/Carer Signature)
Signed: ______________________________________________ Date: ___ / ___ / ___
(Father/Carer Signature)
Signed: ______________________________________________ Date: ___ / ___ / ___
(On behalf of Noah’s Ark Day Nurseries Ltd)
Page 3 of 3