Registration Form

Child's Information

Child's First Name *

Child's Surname *

Date Of Birth *

Home Address *

Ethnicity

Parent Contact Information

Parent/Carer Name *

Parent/ Carer Home Address *

Telephone Number *

Home Number/Alternative Number

Email Address *

Who has parental responsibility for your child? (e.g. the parent/carer who is your child's main carer) *

Does anyone have legal contact with your child? (e.g. a parent who lives at a different address) *

Please provide us with a password in case a person we do not know has to pick up your child in an emergency *

Emergency Contact Information (MUST BE DIFFERENT FROM PARENTS)

Alternative Contact 1 Name *

Home Address

Telephone Number *

Home Number/Alternative Number

Relationship to child *

Alternative Contact 2 Name *

Home Address

Telephone Number *

Home Number/Alternative Number

Relationship to child *

Attendance Schedule

Please select which days you require your child to attend nursery.

Monday

Tuesday

Wednesday

Thursday

Friday

What is your potential start date? *

Health Information

Registered GP, Address & Telephone Number:

Does your child have any special health requirements/disability/medical conditions?

Any known allergies? *

Does your child have special dietary requirements? *

Are all childhood vaccinations up to date? *

Any other information that may be useful for us to know

How did you hear about us? *

Joyful Star Nursery | nursery in south east london | nursery in bermondsey | nursery in se16

Joyful Star Nursery | nursery in south east london | nursery in bermondsey | nursery in se16