Chandler's Cross - The Grove - Application For Enrolment

This form is only to be completed once you have been offered and have accepted a place. For initial enquiries please complete our Enquiry Form on our home page.

All required fileds are marked as *

             
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  Gender * Date of Birth *  
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  *   (To be used when someone other than yourself collect your child from the nursery)  
  WORK DETAILS
    Parent 1's Details   Parent 2's Details  
  Parent Name      
  Occupation    
  Business Name    
  Business Address    
  Work telephone number    
  Mobile telephone number    
  PLEASE GIVE DETAILS OF TWO ALTERNATIVE LOCAL PEOPLE TO NOTIFY IN CASE OF EMERGENCY
    Alternative 1   Alternative 2  
  Full name *    
  Address *    
  Home telephone number *    
  Work telephone number *    
  Mobile telephone number *    
   
  I wish my child to start at Old Macdonald's Day Nursey on  
   
  Name of family doctor      
  Telephone number      
  Address      
  Health visitor      
  CHILD'S HEALTH DETAILS  
  Injections/immunisations already received:please tick with completed date  
 
 
 
Please give details of any allergies , handicaps or chronic condition that we should be aware of: Is there anything else that we should be aware of about your child?
 
  I wish my child to attend:  
 
   
 
 
Full Day
Monday
Tuesday
Wednesday
Thursday
Friday
 
  You will be asked to sign below in person when you come for settling-in sessions, please now click Submit at the bottom of this page  
  AGREEMENT TO CONDITIONS  
  I accept that prior to my child starting Old MacDonald’s Day Nursery, I must read the Policies & Procedures and sign a Childcare Agreement Form.  
  Signed   Mother/Father or Guardian  
  Date        
  I have no objection to still/motion photography being taken of my child for the following purposes:
nursery/student records, my child's own personal records.
 
  Signed   Print  
  I have no objection to still/motion photography being taken of my child for the purpose of printed or social media.  
  Signed   Print  
  I have no objection to still/motion photography being taken of my child by other parents/guardians at nursery events i.e. nativity play.  
  Signed   Print  
  I have no objection to my child being recorded on CCTV whilst on nursery premises.  
  Signed   Print  
  I give permission for observations to be carried out on my child to help staff and students with on-going training.  
  Signed   Print  
  I give permission for my child to go on trips to local places of interest in suitable transport (you will be consulted verbally first).  
  Signed   Print  
  I give permission for my child to be administered Piriton.  
  Signed   Print  
  In the event that my child has a temperature of 37.5°C or higher and the nursery has not yet been able to make contact with me (and it is safe to administer given the time frames and medical advice on the box), I give permission for my child to be administered Calpol as an interim measure to relieve him/her (we will always try to contact a parent first).  
  Signed   Print  
  I give permission for my child to receive medical treatment by trained first aid staff and in serious cases (where we would always try to contact a parent first) by a G.P. or hospital.  
  Signed   Print  
  SPAM CHECK  
  Word Verification* Type the characters you see in the picture below.    
   
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