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020 341 73945(Barnet)
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Child Details
Parental Details
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Child Details
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Gender
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Nationality
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Parent/Carer 1
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Authorised to Collect:
No
Yes
Emergency Contact:
No
Yes
Parental Responsibility:
No
Yes
Bill Payer:
No
Yes
Essentional Worker(Key)
No
Yes
Title
Mr.
Mrs.
Miss.
Ms.
Dr.
Sir.
Prof
The Rev.
The Hon.
Relationship With Child
Mother
Father
Aunty
Brother
Carer
Family Friend
Foster Carer
Grand Parent
Guardian
Sister
Uncle
Other
Parent/Carer 2
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Authorised to Collect:
No
Yes
Emergency Contact:
No
Yes
Parental Responsibility:
No
Yes
Bill Payer:
No
Yes
Essentional Worker(Key)
No
Yes
Title
Mr.
Mrs.
Miss.
Ms.
Dr.
Sir.
Prof
The Rev.
The Hon.
Relationship With Child
Mother
Father
Aunty
Brother
Carer
Family Friend
Foster Carer
Grand Parent
Guardian
Sister
Uncle
Other
Illness and Immunisation Record
Chicken Pox:
Illness
Immunisations
Convulsions:
Illness
Immunisations
Diptheria:
Illness
Immunisations
Hepatitis A:
Illness
Immunisations
Hepatitis B:
Illness
Immunisations
Hib:
Illness
Immunisations
Measles:
Illness
Meningitis B:
Illness
Immunisations
Meningitis C:
Illness
Immunisations
MMR:
Immunisations
Pneumonia:
Illness
Immunisations
Mumps:
Illness
Polio:
Illness
Immunisations
Rotavirus:
Illness
Immunisations
Rubella:
Illness
Scarlet Fever:
Illness
Immunisations
Tetanus:
Illness
Immunisations
Whooping Cough:
Illness
Immunisations
All Immunisations Up To Date:
Immunisations
Doctor's Details
Health Visitor
Dietary Requirements and Allergies
Additional Details
Visual Impairment:
No
Yes
Respiratory Problems:
No
Yes
Regular Medication:
No
Yes
Special Edu. Needs & Disability (SEND):
No
Yes
Please select your preferred booking pattern.
Monday:
Early Drop-off(7:30-8:00 am)
Am Sessions
Am Funded Only
Full Time Daily
Pm Sessions
Late Pickup(6:00-6:30)pm
Tuesday:
Early Drop-off(7:30-8:00 am)
Am Sessions
Am Funded Only
Full Time Daily
Pm Sessions
Late Pickup(6:00-6:30)pm
Wednesday:
Early Drop-off(7:30-8:00 am)
Am Sessions
Am Funded Only
Full Time Daily
Pm Sessions
Late Pickup(6:00-6:30)pm
Thursday:
Early Drop-off(7:30-8:00 am)
Am Sessions
Am Funded Only
Full Time Daily
Pm Sessions
Late Pickup(6:00-6:30)pm
Friday:
Early Drop-off(7:30-8:00 am)
Am Sessions
Am Funded Only
Full Time Daily
Pm Sessions
Late Pickup(6:00-6:30)pm
General Permissions
Administer First Aid
No
Yes
Administer Medication
No
Yes
I give permission for a member of staff to apply an antihistamine cream in the event of an insect bite.
No
Yes
I give permission for a member of staff to apply barrier cream for nappy rash
No
Yes
I give permission for a member of staff to apply teething gel
No
Yes
I give permission for my child to have their face painted at Nursery.
No
Yes
I give permission for staff to administer an emergency dose of Calpol to my child as a reliever for teething pain without any other symptoms.
No
Yes
I give permission for staff to administer an emergency dose of Calpol to my child in the event of my child developing a high temperature. (I will be contacted immediately)
No
Yes
I give permission for staff to apply a plaster if necessary.
No
Yes
I give permission for staff to seek emergency medical advice or treatment if necessary (in the event of the above I will be contacted immediately)
No
Yes
I give permission for sun cream to be applied to my child
No
Yes
Toothbrushing (if required)
No
Yes
Outings
After School club - I give permission for my child to travel on a booster seat in the front seat of a vehicle
No
Yes
After School club - I give permission for my child to travel on a booster seat in the front seat of a vehicleAfter School Club - I give permission for my child to travel on a booster seat using a 3 point seat belt
No
Yes
After School club - I give permission for my child to travel on a booster seat using a rear lap strap (occasional)
No
Yes
I give permission for my child to be taken for local walks
No
Yes
I give permission for my child to be transported by car/minibus
No
Yes
Online and Media
Allow photos and videos for nursery website, social media and facebook ( public page)
No
Yes
Allow photos for child development evidence, Ofsted, display boards & training within nursery
No
Yes
Allow Photos for local and national press
No
Yes
Information and Observations
During the course of their work, all staff are required to carry out observations on all of the children as part of the statutory framework for the Early Years Foundation Stage. I give permission for staff to carry out observations on my child
No
Yes
For parent/carer of a child under 6. I give permission for my child’s key person at this setting to share relevant information with the school where s/he also receives education and care under The Early Years Foundation Stage Framework.
No
Yes
I give permission for the nursery to share information regarding my child’s developmental records/learning journeys with other providers, outside agencies such as the Local Authority, Early Years Teams and at transition visits with school
No
Yes
Confirmation and Digital Signature
I confirm I have read the terms and conditions of the Nursery and agree to comply with them and any updated regulations and instructions where necessary.
Permissions Authorised:
Information Security
Accurate Information
Policies and Procedures
Confirmation & Signature
You ( ) agree to the terms and conditions of the Nursery and agree to comply with them and any updated regulations and instructions where necessary.
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About
OFSTED Report
Admissions
Arrivals and Departures
Child’s Development and Learning
Safety
Parent Pack
Daily Routine
Our Healthy Menu
What Not to Bring to Nursery
FAQs
Our Policy
Food
Health and Safety
Safeguarding
Settling In/Child Induction Policy
Fee Structure
Parent’s Partnership
Terms & Conditions
Kiddicare Nursery
Our Aims and Objectives
