Child Enrolment Form

Step 1 of 7 Completed

Childs Details

It is important that you provide accurate and current information about the child you would like to enrol.

Funding Details
Grant Funded only, No payment Required
Parents Responsible for fees (for sessions not covered by grant funding)
Childs Details
Gender
Please specify the language most spoken at home
Step 2 of 7 Completed

Parental Responsibility

Please provide accurate and current information of parents, guardians and/or carers with legal parental responsibility.

Parental Responsibility Delete Add Parent
Does this person have legal “Parental Responsibility” for the child?
Step 3 of 7 Completed

Child Collection and Emergency Contacts

Please provide accurate and current information of parents, guardians and/or carers who may collect the child.

Emergency Contact Delete Add Contact
Child Collection Details
Please provide the name of the person who will usually collect the child
Please provide a password to collect the child
Alternative Child Collection Details Delete Add Collector
Please provide the name of an alternative person who may collect the child
Step 4 of 7 Completed

Wellbeing and Healthcare

Please provide accurate and current information of healthcare and medical detials.

GP Details
Please provide the name of the childs GP and Practice
Dentist Details
Please provide the name of the childs Dentist and Practice
Health Visitor Details
Please provide the name of the childs health visitor details and clinic
Addtional Healthcare Details
Please provide details of any other professionals involved in your child's care
Special Needs and Disabilities
Please provide details of any special educational needs/disabilities
Medical Details
Does your child have any allergies
Does your child have any pre-existing medical conditions
Illness
Chicken Pox
Whooping Cough
Measles
Scarlet Fever
Polio
German Measles
Diphtheria
Other
Current Immunisations
Diphtheria
Whooping Cough
Hib
Meningitis C
Polio
MMR
Step 5 of 7 Completed

Placement Details

Please provide details of your preferred nursery location and childcare requirements.

Type of Placement

Pinocchio's 1140 hours options (for all 3-5 year olds and eligible two year olds)
Free government grant funded hours provided, no money required for deposit a or grant funded time at Pinocchios
All nurseries: Over 50 weeks / 22 hours and 45 minutes grant funding per week

Option 1: 2 days (8am - 5pm) and 1 day (8am to 12.45pm)
Option 2: 2 days (8am -5pm) and 1 afternoon (1pm - 5.45pm)
Option 3: 3 days (8am - 6pm) during school term time only
Option 4: 5 morning sessions (Monday to Friday)
Option 5: 5 afternoon sessions (Monday to Friday)

All Session flexibility: Drop off up to 15 minutes after session starting (ie: 8.45-9am) and collection up to 15 minutes earlier than sessions finishing (ie: 3.05pm-3.20pm)

Childcare Sessions
Monday
Tuesday
Wednesday
Thursday
Friday
Please provide details of any other childcare sessions required

Note: sessions are subject to availability and can be discussed with site managers.

Step 6 of 7 Completed

Permission and Authorisation

Please provide legal parental responsibility consent to the items listed below.

Medication Consent
I will inform the nursery of my child being given any medicines on the day of attending nursery.
I give consent for a member of Pinocchio’s team to apply suncream.
I give my consent for my child to participate in the toothbrushing programme.

Please Note: the only medication that would be administered by the nursery team must be prescribed by a doctor and individual medical forms signed by the parent/guardian in advance Pinocchio’s Nursery reserves the right to refuse the right to administer medication that requires specific training, without prior training for this.

Medical Treatment Consent

Should your child become unwell whilst at Pinocchio’s we require your consent to treat them

I DO/DO NOT give an employee trained in first aid consent to treat my child
I DO/DO NOT give a doctor or other medical professional consent to treat my child.

I understand that Pinocchio’s will contact me immediately in this event.

Photographic Consent

Please specify your permission consent for us to take photographs/videos of your child to be used:

I DO/DO NOT give permission to be used within the nursery setting.
I DO/DO NOT give permission to be used in newspapers/brochures/posters
I DO/DO NOT give permission to be used on social media
I DO/DO NOT give permission to be used on social media and Pinocchio’s website
I DO/DO NOT give permission to be used for learning journals

Please Note: Inspectors require evidence of the activities we offer the children in our care. Photographs may be used in the nursery in the normal publicity of good work/a positive nursery ethos.

Outings and Trips Consent

Please specify your permission consent for us to take your child on excursion:

I DO/DO NOT give permission to be taken on local walks.
I DO/DO NOT give permission to be taken on outings/trips in the nursery minibus.

Please Note: Permission will be requested in advance of any other trips.

Personal Data
I DO/DO NOT give permission to store and process relevant personal data.
Step 7 of 7 Completed

Terms and Conditions

These Terms and Conditions represent the entire agreement and understanding between the parents and the Nursery

Addtional Information
Previous Pre-Nursery or Childcare Experience
Agreement

We would ask that it is the parents’ responsibility to keep the information contained on this registration form up to date, especially emergency contact details and any allergy/medical details.

NOTICE PERIOD: One full calendar month’s notice must be given if you are leaving or reducing sessions permanently.

NURSERY FEES (non Grant Funded hours):Fees are payable in advance on the 1st day of the month, by Direct Debit/Tax Free Childcare or other approved payment methods. For third party payments, we need written confirmation that funding has been granted before the child starts at the nursery. The parents are ultimately responsible for all payments. Should non-payment continue past one full month, your child will be excluded from the nursery until your account has been paid in full. Failure to comply may result in notice being served and your child’s placement being cancelled. I agree to abide by the terms and conditions and policies and procedures of Pinocchio’s Nursery which I have read and fully understand.

Print Name

Signature

Please draw your signature in the box below and the click the save button.
Signature Instructions

1. Please use your mouse to draw in the signature box in white.

2. You can undo or delete the drawing using the buttons labeled below.

3. Once you are happy with your signature please press SAVE to save the signature before submitting the completed form.