1. I hereby certify that the information provided is correct.
Registration Form
Please return to: Ashburton House, 3 Monument Green, Weybridge, Surrey, KT13 8QR |
Tel: |
CHILD INFORMATION
Child's name
Child's first language
Date of birth
Language spoken at home
Boy / Girl
Health problems (if any)
Ethnicity
Medications
Religion
Immunisations
Address 1
Allergies / special dietary needs
Address 2
Doctor's name
Address 3
Doctor's surgery name
County
Doctor's tel
Postcode
Health Visitor -
name and tel no
Name of past setting & town
Contact at Social Services -
CONTACT DETAILS
Mum's name
Dad's name
Mum's
Dad's
Mum's mobile
Dad's mobile
Mum's work tel
Dad's work tel
1st emergency contact
2nd emergency contact
Emergency contact mobile
Emergency contact home tel
CARE REQUIREMENTS
START DATE
I hereby certify that the information provided is correct.
SESSIONS REQUIRED
AM ONLY
PM ONLY
ALL DAY
I understand that by completing this form it does not wholly guarantee that a place will be reserved.
MONDAY
 Y/N
In the case of emergency I cannot be contacted, I give my permission for my child to be given the necessary treatment.
TUESDAY
I have read and signed the Monkey Puzzle Day Nursery (Weybridge) Terms and Conditions.
WEDNESDAY
Signed
THURSDAY
Print name
FRIDAY
Date
Please ensure that you now read the Nursery Policies and Procedures. Thank you for registering
Bank: Natwest A/c: Nikki’s Nurseries Ltd A/c no: Sort code:
A Monkey Puzzle Day Nursery Franchise owned and operated under licence by Nikki’s Nurseries Ltd, registered in England & Wales Company no Registered office: Unit C3, Fairoaks Airport, Chobham, Surrey, GU24 8HU