Daisy Chain Day Nursery & Baby Daisy Chain-Crawley Registration
Daisy Chain Day Nursery & Baby Daisy Chain-Crawley Registration Form 194 Three Bridges Road Crawley West Sussex RH10 1LR 190A Three Bridges Road Crawley West Sussex RH10 1LN You are required to complete this form to book at place for your child. Please submit this form accompanied by the non-refundable Registration Fee of £50.00 (if applicable). By completing this form you are agreeing to abide by the Terms & Conditions. Payments may be made by bank transfer, cheque or cash. You will receive a letter to confirm your place at Daisy Chain. Child’s Details M
First name:
Last Name:
D.O.B.:
Religion:
Ethnicity:
First Language:
F
Childs Address: Post Code: Parent/Carer Personal Details Title*
Mr
Mrs
1 Miss
2 Ms
Dr
Mr
Mrs
Miss
Ms
Dr
First name* Last name* Relationship to child Do you have parental responsibility? Home address if different from child’s home address*
Yes
No
Yes
Town: County:
No
Town: County:
Post code*
_____/______
Home phone no*
(
)
Work phone no
(
)
Please tick
_____/______
first no
(
)
to call
(
)
EMERGENCY
Mobile no*
EMERGENCY
Email address Please tick first no to call
Employer (Company Name) Occupation
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Sessions Required: Please tick the sessions you require for your child.
Please note there are only limited places for Term-time only and the additional hours, so these will be confirmed if available.
‘Funded only’ hours are allocated as ‘stretch funded’ over the full 52 weeks per year. If you require a funded only place this can be booked as either 2 half days or one full day per week.
Monday
Tuesday
Wednesday
Thursday
Friday
7.30-8.00am AM (8-1) PM (1-6) Full day (8-6) Additional hours (e.g. 1.00-2.30) Preferred Starting Date:
White - British White – Irish Any other White background Asian or Asian British - Indian Asian or Asian British – Pakistani Asian or Asian British – Bangladeshi Any other Asian background Chinese
Ethnicity Mixed – White and Black Caribbean Mixed – White and Black African Mixed –White and Asian Any other Mixed background Black or Black British – Caribbean Black or Black British – African Any other Black background Any other Ethnic Group
Parent/Carer Declaration – In registering my child, at Daisy Chain Day Nursery , I have read, understood and agree to abide by all the Terms & Conditions laid down by Salolach Childcare Ltd. Parent/Carer Signature:
Date
Data Protection: In compliance with current UK Data Protection legislation, any information you provide to us will be kept
secure and treated confidentially. This data collected will only be used by Daisy Chain day Nursery and will not be disclosed to any external sources without your prior consent.
Safeguarding Disclaimer. Information for parents placing their children in registered childcare provision in West Sussex. As a provision, registered with Ofsted, we are required by West Sussex County Council to inform you of the following information. “Dear Parents/Guardian, As you may know the valuable services offered by providers of registered childcare for children under the age of 8 years are subject to regulation by Ofsted. The purpose of regulation is to protect children, to provide reassurance to those who are arranging for their children to be looked after and to ensure that services meet the requirements of the Early Years Foundation Stage. Ofsted’s Childcare Inspectors carry out regular inspections to ensure the setting continues to meet these requirements and that the children are well looked after. There is a specific legal requirement that all providers safeguard and promote the welfare of the children in their care. This means that they have a responsibility to report any concerns regarding a child in their care. Steps taken must be in accordance with the Local Safeguarding Children’s Board Procedures. This ensures, where necessary, action is taken to protect children from harm. It is important to remember that the guiding principles of the procedures and the supporting legal framework are that the needs of the child are paramount and that children have the right to be safeguarded from harm. However we do recognise that this process can be very distressing for parents”. WSCC We are required to bring this matter to the notice of all parents so that you are fully aware of the procedure we have to follow in these circumstances.
Recommend a Friend Scheme. If you have been recommended by a friend, please tick here, and add their details. You will qualify for free registration fee, and they will qualify for some free sessions.
Person who made the recommendation:-
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First name:
Last Name:
D.O.B.:
Religion:
Ethnicity:
First Language:
F
Childs Address: Post Code: Parent/Carer Personal Details Title*
Mr
Mrs
1 Miss
2 Ms
Dr
Mr
Mrs
Miss
Ms
Dr
First name* Last name* Relationship to child Do you have parental responsibility? Home address if different from child’s home address*
Yes
No
Yes
Town: County:
No
Town: County:
Post code*
_____/______
Home phone no*
(
)
Work phone no
(
)
Please tick
_____/______
first no
(
)
to call
(
)
EMERGENCY
Mobile no*
EMERGENCY
Email address Please tick first no to call
Employer (Company Name) Occupation
Page 1 of 2
01/15
Sessions Required: Please tick the sessions you require for your child.
Please note there are only limited places for Term-time only and the additional hours, so these will be confirmed if available.
‘Funded only’ hours are allocated as ‘stretch funded’ over the full 52 weeks per year. If you require a funded only place this can be booked as either 2 half days or one full day per week.
Monday
Tuesday
Wednesday
Thursday
Friday
7.30-8.00am AM (8-1) PM (1-6) Full day (8-6) Additional hours (e.g. 1.00-2.30) Preferred Starting Date:
White - British White – Irish Any other White background Asian or Asian British - Indian Asian or Asian British – Pakistani Asian or Asian British – Bangladeshi Any other Asian background Chinese
Ethnicity Mixed – White and Black Caribbean Mixed – White and Black African Mixed –White and Asian Any other Mixed background Black or Black British – Caribbean Black or Black British – African Any other Black background Any other Ethnic Group
Parent/Carer Declaration – In registering my child, at Daisy Chain Day Nursery , I have read, understood and agree to abide by all the Terms & Conditions laid down by Salolach Childcare Ltd. Parent/Carer Signature:
Date
Data Protection: In compliance with current UK Data Protection legislation, any information you provide to us will be kept
secure and treated confidentially. This data collected will only be used by Daisy Chain day Nursery and will not be disclosed to any external sources without your prior consent.
Safeguarding Disclaimer. Information for parents placing their children in registered childcare provision in West Sussex. As a provision, registered with Ofsted, we are required by West Sussex County Council to inform you of the following information. “Dear Parents/Guardian, As you may know the valuable services offered by providers of registered childcare for children under the age of 8 years are subject to regulation by Ofsted. The purpose of regulation is to protect children, to provide reassurance to those who are arranging for their children to be looked after and to ensure that services meet the requirements of the Early Years Foundation Stage. Ofsted’s Childcare Inspectors carry out regular inspections to ensure the setting continues to meet these requirements and that the children are well looked after. There is a specific legal requirement that all providers safeguard and promote the welfare of the children in their care. This means that they have a responsibility to report any concerns regarding a child in their care. Steps taken must be in accordance with the Local Safeguarding Children’s Board Procedures. This ensures, where necessary, action is taken to protect children from harm. It is important to remember that the guiding principles of the procedures and the supporting legal framework are that the needs of the child are paramount and that children have the right to be safeguarded from harm. However we do recognise that this process can be very distressing for parents”. WSCC We are required to bring this matter to the notice of all parents so that you are fully aware of the procedure we have to follow in these circumstances.
Recommend a Friend Scheme. If you have been recommended by a friend, please tick here, and add their details. You will qualify for free registration fee, and they will qualify for some free sessions.
Person who made the recommendation:-
Page 2 of 2
01/15
