Registration Form


Section One


We need some details about your child and family. We have a legal obligation to collect and process this information in accordance with The Early Years Foundation Stage (Welfare Requirements) Regulations 2012 and therefore we do not require your consent for the first section of this form. Where information to be supplied is voluntary or where we do need consent this is identified. The information provided will be uploaded onto our secure software database and used for the purpose of maintaining appropriate contact details and for the safety and well-being of your child.


Emergency Contact Details

Please provide the names and contact details of 2 people (other than parents/guardians) who we can contact in case of an emergency who can collect your child. Please note that they must be over the age of 18 years of age.

NOTE: It is your responsibility to ensure these people are happy for us to contact them and to hold their details.


Emergency Contact 1

Emergency Contact 2

Security

A password system operates in our setting. A secure password is required and should be used by emergency contacts and persons authorised to collect your child. Ideally this should be one word and something that is easily memorable. Please do not use obvious things such as middle names. The password is required from anyone colleting your child. If they do not have the password we will not release your child to them.

Persons authorised to collect the child. This is any other adult who may collect your child in your absence. Authorised persons must be over 18 years of age.

Authorised Person 1

Authorised Person 2

We have the safety and well-being of the children in mind at all times and we are sure that you will appreciate that persons known to you are strangers to us and we do need means of identifying those you have authorised to collect your child (either authorised or emergency contacts) when you are unable to.

We as a setting and especially your child/children key person will be familiar with you but we do not always have the opportunity to meet both parents. This is also true of your nominated emergency contacts and authorised persons. We therefore request that should anyone unknown to us be collecting your child that you inform us in advance and show us a photograph to enable us to identify them when they collect your child.

Health Information

AsthmaHeart ConditionDiabetesSight impairmentEpilepsyKidney / bladder problemsBee sting allergyDeafness

Safeguarding Children

Please note that if the child has a child protection plan, these will be obtained from the social worker named above and keep these securely in the child’s named Child Protection file.


Section Two


The following information is voluntary and you do not have to complete it. However, we have a legitimate interest in requesting this data as it will assist in providing the necessary care for your child and to allow us to monitor and assess their development.

Health Visitor

The following section requires information classed as ‘sensitive personal data’ for which we need your consent to collect and process. We request this data as, in some cases we have a contractual obligation to do so with our Local Authority, but also as we have a legitimate interest to allow us to plan and meet your child’s needs.

Ethnicity and Cultural Background

Special Educational Needs and Disabilities

Professionals involved with the child

The following section contains information for which we need your consent. As required by data protection we have a duty to inform you that you can withdraw your consent for any of the permissions detailed below at any time. Should you wish to withdraw consent please discuss this with a member of staff in the first instance.

Permissions and Consent

If emergency treatment is required, either whilst your child is on the premises or on an outing, (for the duration of your child’s time with us) and the parents or legal guardians cannot be reached immediately, your signature in the space provided below empowers the settings management to exercise their own judgement in calling the doctor/dentist indicated above or to transport the child to a hospital casualty department by ambulance. Please read and fill in the declaration below, and sign and date this section.

give consent on my / our behalf for an anaesthetic to be administered or for any other urgent medical treatment to be given.

I / We do not agree to this statement and indicate our wishes as follows:

Permission for the application of sun cream

I give permission for KTB Kids Day Nursery to apply their own supply of high factor children’s sun cream to my child.

Administration of Calpol consent form

KTB Kids will administer a maximum of 5ml of Calpol in the situation of your child having a raised temperature and in accordance with our Medication Policy. Calpol will only be given following telephone contact with the parent/ guardian as an interim measure whilst waiting for the child to be collected from the nursery. KTB Kids will not administer Calpol in any other circumstances apart from those set out in the Medication Policy.

I give permission for KTB Kids Day Nursery to administer a maximum of 5ml of Calpol to my child in line with the administration of medicine policy.

Please tick the statements below if you consent to the following:

I consent to my child participating in off-site outings as part of daily practice e.g. trips to the park, shops, etcI consent to my child participating in off-site outings as part of daily practice using public transport to further benefit from the wider communityI consent to my child having their photograph taken for use in displays, for name pegs, etc within the settingI consent to my child having their photograph taken to be used for publicity purposes – website, flyers.I consent to my child’s photograph being used on the settings social media sitesI consent to my child’s artwork (with their name) being displayed in the settingI consent to my child’s photograph being used in learning journeys of other children within the settingI consent to my child being videoed for use by the setting staff only with regards to observational purposes either assessment of children, an activity or for monitoring children’s behaviourI consent to the video, as mentioned above, to be shared with other professionals visiting the group such as Early Years Advisors, SENCO, Health Visitor etc if necessaryI consent to my child’s learning journey being shared with Ofsted inspectors and/or as part of audits by the local authorityI give permission for an online LearningBook Learning Journal to be created and maintained for my child.I give my consent for my child to have face paints applied.

Please sign below to confirm your consent for the indicated statements above:

Further information regarding how we use children’s images within the setting can be found in our Image Use Policy.

I / We confirm that the information provided on this form is correct to the best of our knowledge. I understand that there is a one month notice period to terminate my contract at the nursery and that there are penalty fees for late collection and late payment. I have been sent the KTB Kids Admissions Handbook and am happy with the nursery practices and policies.

Signature of Parent (s)/Carer (s)

Sessions Required:

Monday:

Tuesday:

Wednesday:

Thursday:

Friday: