Pre-School Registration Form (Page 2 of 2) in pdf

Grange Tiny Hands Pre-school

Name of child’s Doctor:-________________________ Health visitors name: - _____________________

Practice address: - ______________________________________________________________________

TEL. No.:- ____________________________________

Does your child have any ALLERGIES? YES ( ) or NO ( ) Please TICK and give details below: -

_______________________________________________________________________________________

Any comments for the Pre-school Manager:-

Does your child have an Early Support Plan or CAF in place? : YES / NO

SIGNED: - _____________________________________ (Parent/Guardian)

Date: - _____________

SECTION B

EMERGENCY MEDICAL TREATMENT

If __________________ requires medical treatment URGENTLY and parents cannot be contacted within a

reasonable time, we hereby give our consent for any necessary medical treatment by a qualified doctor/nurse

on site or at surgery or hospital.

Signed :_________________________________________( Parent/Guardian)

Please give information about which vaccinations your child has had:-

_______________________________________________________________________________________

SECTION C – Completion of this section is your choice

Ethnic origin of Mother: - __________________________ (e.g. Irish, English, Afro-Caribbean, Asian etc.)

Ethnic origin of Father: - __________________________ Child’s religion: - ___________________________

Any cultural requirements? (E.g. Regarding diet, religious festivals etc.)

_____________________________________________________________________________________

PARENTS OCCUPATIONS: - Mother: - _______________________

Father:-______________________

Where did you hear about us? _____________________________________________________________

Pre-School Registration Form Page 2