Holiday Scheme Registration

*Indicates a required field

Child’s Details

Name of Child*

Address*

Post Code*

Date of Birth* (dd/mm/yyyy)

Any Allergies/ Intolerances* (If not applicable, please write N/A)

Any health issues we need to be aware of* (If not applicable, please write N/A)

Parents Details

Mother’s Name*

Work Telephone*

Mobile*

Email address*

Father’s Name*

Work Telephone*

Mobile*

Email address*

Please note that if there is an accident or emergency, parents will be contacted first. In case we are unable to reach you we may need to transport your child to the hospital and admit them there. We need permission from you to do so.

In case of emergency, I give permission for any emergency medical advice or treatment as considered necessary by medical authorities present.*

Other information

Activities and play my child enjoys*

Anything else we need to know about your child (likes, dislikes, fears, comforter, special words)*

I have read the holiday scheme policy and acknowledge that there is a copy of policies for me to read at the nursery. I understand that I can also request a full policy pack to be sent to me via email for me to read at my convenience. It is my responsibility as a parent to read what is set out in the nursery policies and I agree to abide by what has been set out. *

I agree all the terms and conditions on this registration form.*