Registration

Child's Name

Access Code (Ignore if unknown)

I understand this does NOT guarantee my child's place until confirmed by the Nursery Manager.

Is your child entitled to funding?

Yes No

Monday:

Full Day (07:30 - 17:30) Half Day AM (07:30 - 12:30) Half Day PM (13:00 - 17:30)

Tuesday:

Full Day (07:30 - 17:30) Half Day AM (07:30 - 12:30) Half Day PM (13:00 - 17:30)

Wednesday:

Full Day (07:30 - 17:30) Half Day AM (07:30 - 12:30) Half Day PM (13:00 - 17:30)

Thursday:

Full Day (07:30 - 17:30) Half Day AM (07:30 - 12:30) Half Day PM (13:00 - 17:30)

Friday:

Full Day (07:30 - 17:30) Half Day AM (07:30 - 12:30) Half Day PM (13:00 - 17:30)

Registration Fee (£100) - Powered by Stripe Payment Processor

Date of Birth

Gender

Birthplace

Ethnicity

Nationality

Religion

First Language

Second Language (If Applicable)

Is your child subject to a Court Order?

Yes No

Address where the child resides

Parent 1 - Name

Relationship to child

Address

Postcode

National Insurance Number (No spaces)

DOB

Mobile Number

Home Number

Work Phone

Occupation

Do you have parental responsibility?

Do you wish to add a second parent?

Yes No

Parent 2 - Name

Address

Relationship to child

Postcode

National Insurance Number (No spaces)

DOB

Mobile Number

Home Number

Work Phone

Occupation

Does parent 2 have parental responsibility?

Photo of Child

Photo of Parent 1

Photo of Parent 2

Does your child have any siblings?

Yes No

Collection Password

How many contact points do you wish to add? (Contact points can pickup/dropoff and Emergency Contacts are called during emergencies)

No Contact Points 1 2 3

I understand that it is imperative that the information in this section is completed in full and reviewed on a regular basis.

Nursery should be informed immediately, should there be any change to the information detailed below.

Does your child have any known Allergies?

Yes No

Does your child have any diagnosed medical conditions?

Yes No

Does your child need to take any prescribed medication on a regular basis?

Yes No

Please list any special dietary requirements your child may have:

Doctor’s Name

Doctor's Street

Doctor's City

Doctor's Postcode

Doctor's Contact Number

Health Visitors Name

Contact Number

Support Agencies e.g. portage workers, Speech Therapists etc

Contact Number

Was your child born prematurely?

Yes No

If your child develops a high temperature above 38°C that cannot be lowered by cooling methods, we will make every effort to contact you or your nominated emergency contacts to collect your child from nursery and for you to administer children’s Paracetamol to reduce your child’s temperature. In the event that you are unable to return and you are unable to make arrangements to have your child collected or someone else to administer Paracetamol within a reasonable time, we will accept your verbal permission to administer emergency Paracetamol. Your child must have been in nursery for more than 4 hours and you must confirm that your child has not, in the last 24 hours, taken 4 or more doses of any medication containing Paracetamol. If we are unable to contact you or your emergency contacts, we reserve the right to seek medical advice by calling NHS Direct on 111 or an ambulance. If requested, we will administer the recommended dose for the child’s age of children’s Paracetamol from our own emergency supply. * We use the brand ‘Calpol’ as our form of liquid paracetamol. To enable us to administer this medication we require you to complete the following: I confirm that my child is not allergic to children’s Paracetamol. I give my consent for the nursery to contact NHS Direct or the Ambulance Service if they are unable to contact myself or my nominated emergency contacts to return to nursery to collect my child and administer children’s Paracetamol in a reasonable time when my child’s temperature cannot be reduced below 38°C. I agree to sign the Sudden Illness Assessment form when I collect my child from nursery, to confirm I have been made aware that this medicine has been administered. I understand that the nursery can only give one dose of children’s Paracetamol and that if my child’s temperature rises again or after 45 minutes my child’s temperature has not reduced, I must make arrangements to collect my child or an ambulance will be called.

Date Agreed

Parent Signature

If my child has an unexplained allergic reaction, I understand the nursery will seek immediate advice from either NHS Direct or the Ambulance Service who may advise immediate administration of an Antihistamine. I therefore give my permission for administration of Nursery Antihistamine based on medical advice received.

Date Agreed

Parent Signature

Your child's favourite stories, songs and rhymes

Favourite Toys and Games

What comforts, soothes or calm my child

Things which can upset, frighten or worry my child

What experience does your child have of playing with other children?

What stage of toilet training is your child at?

Any activities that your child participates in outside of nursery? e.g. swimming

Is there anything you would like us to know or are concerned about?

I acknowledge that by submitting this form that it does not guarantee your child a place at Apple Trees Nursery. Please note the nursery will be in touch to confirm your childs place.

I, Parent 1 confirm that all information provided is correct and I understand that any changes should immediately be updated, I also agree the terms and conditions of the nursery located here: https://appletreesnursery.com/wolverhampton/Registration%20Terms%20and%20Conditions.pdf.

Parent 1 Signature

Registration Form

Join the waiting list today

We are currently accepting children for the waiting list. We advise you speak to a member of management before filling in the form below.

Please fill in the information form below and a member of staff will be in touch

Quality Childcare Wolverhampton

Apple Trees Day Nursery