Registration Form

Derby: 07711 118454 Osmaston: 07852718722 Littleover: 07970382972

Registration Formlittlefoxlittleangelsdaynurseryadmin2023-01-17T10:31:10+00:00

Register a Place

If you would like to register a place with us, please complete the online form below. Alternatively, you can download the form here, complete it and return it to us.

Registration Forms

Child's Details

Name of Setting

Name

First

Last

Date of Birth

Age

Address

Postcode

Home Languages

Additional Languages

Gender

Ethnicity

Religion

Any Celebrations/ Events that you celebrate at home:

2 Year Code

30 Hour Funding Code

Paying

Yes

Health Visitor Name

Birth Certificate Number

Who has parental responsibility? (names on child's birth certificate)

Parent 1

Name

First

Last

Date of Birth

National Insurance Number

Telephone Number

Parental Responsibility

Yes

Address if different from above

Work Details if Applicable:

Work Place

Work Contact

Parent 2

Name

First

Middle

Last

Date of Birth

National Insurance Number

Telephone Number

Parental Responsibility

Yes

Address if different from above

Work Details if Applicable:

Work Place

Work Contact

Emergency Contact Details

Password Agreed

Name

First

Middle

Last

Relationship to Child

Contact Number

Address

Postcode

Name

First

Last

Relationship to Child

Contact Number

Address

Postcode

Doctors Details

Practice Name

Address

Postcode

Telephone Number

Doctors Name

Are immunisations all up to date?

Yes

Do your child have any allergies or dietary requirements? If yes, please give details.

Are there any other health conditions we need to be aware of? E.G asthma, skin conditions etc.

Any other information you would like to share:

Do you have any concerns in regards to your child’s learning E.G speech, hearing, physical?

Has your child had their two year old check completed by the health visitor? Were there any concerns shared here?

Is their any other information you would like to share with us?

Permissions

Can your child have suncream applied whilst at nursery?

Yes

Can your child go on outings/ trips?

Yes

Can your child go on class dojo?

Yes

Can your child be in group photo's which will be shared on our class dojo?

Yes

Can your child have photo’s put on our social media page? E.G facebook, Instagram

Yes

Other Services

Do you have any agencies working with your family? E.G - Health Visitors, Social Workers, Family workers?

Has your child attended any other settings? E.G nurseries, playgroups

Setting Name

Telephone Number

Address

Any other information you would like to share:

To be completed by a staff member:

Start Date

Keyworker

Proof of Address

Parent/carers signature:

Text

If you are human, leave this field blank.

Contact Us

Little Angels Day Nursery 07711 118454 littleangelsmarble@gmail.comLittle Angels Playschool C.I.C 07852 718722 littleangelsderby@gmail.comLittle Angels at St Andrews Preschool Trading under St Andrews Preschool C.I.C 07970 382972 standrewspreschool58@gmail.com

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