Nursery Registration Form

Child's First Name

Child's Last Name

Child's Date of Birth

Child's Address Line 1

Child's Address Line 2

Town

Post Code

Child's Ethnicity

Language(s) spoken at home

COLLECTION PASSWORD

Medical Conditions

Allergies / Food intolerance

Professionals involved with your family

Are you eligible for a funded childcare place? (Please visit www.childcarechoices.org.uk for more information)

We are eligible for 15 hours of funded childcare

We are eligible for 30 hours of funded childcare

We are not sure if we're eligible for funded childcare

Does your child attend another childcare setting (nursery, childminder)? If so, please provide details here.

When would you like your child to attend?

Parent/carer 1 full name:

Parent/carer 1 email:

Parent/carer 1 contact number:

Choose your pizza toppings:

Olives

Mushrooms

Pineapple

Extra cheese

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