Chorleywood - 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 fields are marked as *

             
  *      
  Gender * Date of Birth *  
  *      
       
       
       
       
  *      
  *      
  * (To be used when someone other than yourself collect your child from the nursery)
    Parent 1's Details     Parent 2's Details
  Parent's Name *      
  Home address *    
  Home telephone number *    
  Mobile telephone number *    
  Work telephone number *    
  Occupation    
  Business Name    
  Business Address    
  E-Mail 1 *    
  E-Mail 2    
  Marital status *    
  Mother's title    
  I confirm Parent 1 (as detailed above) has Parental Responsibility for the child named on this Enrolment Form    
  I confirm Parent 2 (as detailed above) has Parental Responsibility for the child named on this Enrolment Form    
  PLEASE GIVE DETAILS OF TWO LOCAL ALTERNATIVE EMERGENCY CONTCATS N.B. THESE MUST BE TWO CONTCATS THAT ARE ABLE TO REACH THE SETTING READILY IN THE EVENT OF AN EMERGENCY.
  Full name *    
  Home telephone number *    
  Mobile telephone number *    
  Work 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 , disabilities 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:  
 
 
  If you have selected part week or half day, please complete the following:  
 
Full Day Half Day Morning Half day afternoon
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 Limited, I must read the Policies & Procedures and sign a Childcare Agreement Form.  
  Signed .............................. Parent of Guardian Print ......................... 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 ......................... Date .........................
  I have no objection to still/motion photography being taken of my child for the purpose of printed or social media.  
  Signed .............................. Print ......................... Date .........................
  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 ......................... Date .........................
  I have no objection to my child being recorded on CCTV whilst on nursery premises.  
  Signed .............................. Print ......................... Date .........................
  I give permission for observations to be carried out on my child to help staff and students with on-going training.  
  Signed .............................. Print ......................... Date .........................
  I give permission for my child to go on trips to local places of interest in suitable transport.  
  Signed .............................. Print ......................... Date .........................
  I give permission for my child to be administered Piriton.  
  Signed .............................. Print ......................... Date .........................
  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 ......................... Date .........................
  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 ......................... Date .........................
  Old MacDonald’s Day Nursery Limited’s Privacy Notice for Parents and their Children is available on our website. I acknowledge that I have read and understood the nursery’s Privacy Notice for Parents and their Children.  
  Signed .............................. Print ......................... Date .........................
  I agree for the information on this form to be retained and stored by Old MacDonald’s Day Nursery Limited in accordance with their Privacy Notice for Parents and their Children & GDPR rules.  
  Signed .............................. Print ......................... Date .........................
  I choose to opt-in whoever’s details are submitted on this form to receiving communication from Old MacDonald’s Day Nursery Limited by e-mail, phone and post.  
  Signed .............................. Print ......................... Date .........................
  I agree to inform Old MacDonald's Day Nursery Limited verbally and by e-mail should any of the above details change.  
  Signed .............................. Print ......................... Date .........................
  SPAM CHECK  
  Word Verification* Type the characters you see in the picture below.    
   
Refresh
   
       
    Enter the text in the image and letters are not case-sensitive