Registration Form | Cippenham Nursery School

Short Consent Form (Appendix H) & Nursery Registration Form

Registration Form

Child's First Name:

Max length 120 characters

Child's Last Name:

Max length 120 characters

Child's Gender: *

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Child's Date of Birth:

Are you seeking asylum? *

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If seeking asylum, please tell us when your child arrived in this country:

Which funding are you looking for? *

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Which session would you prefer at Cippenham Nursery? *

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Full Address

Max length 120 characters

Post Code:

Max length 120 characters

Primary Parent / Carer Full Name:

Max length 120 characters

Relationship to Child: *

Select

Primary Parent / Carer Contact Number:

Max length 120 characters

Primary Parent / Carer Email:

Parent / Carer Full Name:

Max length 120 characters

Relationship to Child: *

Select

Parent / Carer Contact Number:

Max length 120 characters

Parent / Carer Email:

Max length 120 characters

Does the child have any siblings? *

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Have any siblings attended Cippenham Nursery School?

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Siblings DOB and current school attending:

Max length 500 characters

Does your child have a Child Protection Plan? *

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Is English your spoken home language? *

Select

Home language if not English:

Max length 120 characters

Support required with English?

Yes - For Parent(s) / Carer(s)

Yes - For Child

Does your child attend any other childcare provision ? Please name (exmple: childminder, another nursery)

Max length 500 characters

Does your child have any of the following?

Allergies

Speech and Language

SEND

None

Is there anything you think we need to know about your chid or family (e.g. family setup, additional support)

Max length 500 characters

I understand that I must also submit the Short Consent Form (Appendix H) for my application form to be accepted. *

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Short Consent Form (Appendix H)

I confirm that I am the legal parent / carer for the child named below and that the information on this form is correct. I agree that you may use the information I have provided to process my claim for a free early education place and to contact other sources, as allowed by law, to verify my initial and ongoing entitlement. I agree that the information may be used to assess further benefits for my child and my child's school (or other setting), to ensure accuracy of records across the local authority and th check against fraud. I agree that my chosen early years provider may share information about my child's progress as part of ongoing research to support the development of services for young children in Slough.