| Question time! | ##### Please write your answers as clearly as possible! ##### |
| Your child's surname | > |
| First names | > |
| Date of birth | > Sex |
| Nationality | > |
| Address Number & Road |
> > |
| Town | > |
| County | > |
| Post Code | > Phone |
| Mum's first name & surname | > |
| Where mum works | > |
| In which town | > |
| Mums phone number at work (inc STD) | > Ext |
| Mums mobile | > | Dad's first name & surname | > |
| Where dad works | > |
| In which town | > |
| Dad's phone number at work (inc STD) | > Ext |
| Dad's mobile | > |
| Child's doctor's name | > |
| Doctors Address | > |
| Doctors phone number (inc STD) | > |
| More details about your child | |
| Ethnic origin | > |
| Health problems, Allergies etc. | > |
| Medications required | > |
| Special diet or preferences | > |
| Special needs | > |
| Immunisation details | > |
| Other emergency contacts:- Names & Phone numbers |
1. 2. |
| Persons authorised to pick up child | 1. 2. 3. 4. |
| Religion | > |
| Medical procedures prohibited by religion or belief |
> > |
| Sleeping patterns | > |
| Favorite toys, comforters or pastimes | > |
| Any unusual or unique words | > |
| Anything else we should know | > > |
| Start date required | > |
| Parent or guardians signature | > |
| Date | > |
| Please circle below the sessions you will require | |||||||||||
| Monday | Tuesday | Wednesday | Thursday | Friday | |||||||
| AM | PM | AM | PM | AM | PM | AM | PM | AM | PM | ||
PLEASE ENCLOSE DEPOSIT OF £50 TO RESERVE YOUR CHILDS PLACE.
THIS WILL BE DEDUCTED FROM YOUR FINAL INVOICE
SUBJECT TO THE RECEIPT OF ONE FULL CALENDAR MONTH'S NOTICE.