Registration form

Please complete the below steps to register a place for your child at one of our nurseries.

Step 1 of 11

Child's details

Nursery name(Required)

Child's name(Required)

First Name

Last Name(Required)

Last Name

Preferred Name(Required)

Preferred Name

Date of birth/ Due date(Required)

DD slash MM slash YYYY

Legal gender(Required)

Birth Certificate number

Religion

Ethnicity

First spoken language(Required)

Please provide first spoken language(Required)

Please provide first spoken language

Who the child resides with(Required)

Search Address by Postal Code

Address(Required)

Address Line 1 Address Line 2 City Postcode

Booking Details

Preferred start date(Required)

DD slash MM slash YYYY

Please indicate the sessions / days you require by selecting the buttons below:

Monday

Morning

Afternoon

Tuesday

Morning

Afternoon

Wednesday

Morning

Afternoon

Thursday

Morning

Afternoon

Friday

Morning

Afternoon

If applicable, please provide the name of any siblings who attend the nursery

Are you eligible for Blue Light discount? (Ts & Cs apply)

Yes

Your Blue Light membership number(Required)

Your Blue Light expiry date(Required)

Parent / Carer 1 Details

Bill Payer 1(Required)

Will this contact be the main bill payer for this account?

Yes

Title(Required)

First Name(Required)

First Name

Last Name(Required)

Last Name

Date of birth(Required)

DD slash MM slash YYYY

Relationship to child(Required)

National Insurance Number (this is required to process your childcare funding)(Required)

Search Address by Postal Code

Address(Required)

Address Line 1 Address Line 2 City Postcode

Contact details

Home telephone

Mobile telephone

Work telephone

Place of work

Email(Required)

Permission(Required)

Do you give permission for Partou to contact you with marketing updates such as promotions, offers and events? For more information on how your data is used, please visit: partou.co.uk/privacy-policy

Yes

Parent / Carer 2 Details

Bill Payer 2

Will this contact be the main bill payer for this account?

Yes

Title(Required)

First name(Required)

First name

Last name(Required)

Last name

Date of birth

DD slash MM slash YYYY

Relationship to child

National Insurance Number (this is required to process your childcare funding)

Search Address by Postal Code

Address

Address Line 1 Address Line 2 City Postcode

Contact details

Home telephone

Mobile telephone

Work telephone

Place of work

Email address

Permissions 2

Do you give permission for Partou to contact you with marketing updates such as promotions, offers and events? For more information on how your data is used, please visit: partou.co.uk/privacy-policy

Yes

Emergency Contact details

Emergency Contact 1

Title(Required)

First name(Required)

First name

Last name(Required)

Last name

Relationship to child(Required)

Search Address by Postal Code

Address(Required)

Address Line 1 Address Line 2 City Postcode

Preferred contact number

Email address

Emergency Contact 2

Title(Required)

First name(Required)

First name

Last name(Required)

Last name

Relationship to child

Search Address by Postal Code

Address

Address Line 1 Address Line 2 City Postcode

Preferred contact number

Email address

Government Funding Details

Please indicate whether you will be applying any government funding to your bookings by ticking the relevant boxes below. Please note you can only apply one funding type per booking.

For children 3 years +

15 hours free entitlement (for all families)

15 hours free entitlement (for working families)

For 2 year olds

30 hours free entitlement (for working families)

15 hours free entitlement (for families receiving additional government support)

For children under 2

30 hours free entitlement (for working families)

Please provide details of your funding eligibility

Your funding code

When your funding code is eligible from

DD slash MM slash YYYY

Will you be splitting your funding entitlement with another provider?

Yes

Name of provider you are splitting entitlement with

Third Party Payments Details

Please fill in the details below if your nursery fees will be paid for by a third party (such as a college/ employer)

Name of Third Party (person or organisation making the payment)

Contact Name at Third Party (if Third Party is an organisation)

Telephone number

Email address

Third Party Agreement

By providing third party payment information:

I/we confirm that the above person/entity is responsible for paying nursery fees for the child detailed on this form
I/we agree to provide the nursery with any necessary paperwork for the third party
I/ we are aware that a contribution may be required to the fees based upon the terms and conditions of the third party
I/we are aware that the third party may require forms to be completed in relation to changes to the fees/bookings, and that responsibility for the completion of these fees is solely mine/ours
I/we are aware that until the third party agreement is confirmed, the nursery place cannot commence
I/we are aware that should the third party stop paying for the nursery place that I/we will be liable for the outstanding fees

Doctor & Health Visitor Details

Doctor

Doctor's Name

Search Address by Postal Code

Address

Address Line 1 Address Line 2 City Postcode

Contact Number

Health Visitor

Health Visitor's Name

Search Address by Postal Code

Address

Address Line 1 Address Line 2 City Postcode

Contact Number

Please tick to confirm that your child is up-to-date with the following vaccinations:(Required)

DPT 1

DPT 2

DPT 3

MEN C

MMR

MEN B

Polio

Tetanus

Whooping Cough

None of the above

Social Services and Family Support

Have social services worked with your child or family?(Required)

Yes

Are social services currently working with the child or family?(Required)

Yes

Please provide details of the support plan that is/was in place for the child/family:

Name of social worker

Contact number for social worker

Does the child have any special educational needs or disabilities?(Required)

Yes

Please provide details

Does the child have any medical conditions?(Required)

Yes

Please provide details

Do you give permission for the nursery to use sun cream?(Required)

Yes

Do you give permission for your child to take part in local trips?(Required)

Yes

Do you give permission for photographs/ videos of your child to be used within the company for the purpose of learning and development?(Required)

Yes

Do you give permission for photographs/ videos of your child to appear on social media platforms? (children’s names will never be used)(Required)

Yes

Do you give permission for photographs/ videos of your child to be used for marketing purposes? (children’s names will never be used)(Required)

Yes

Do you give permission for the nursery to administer and seek emergency first aid, including the use of plasters?(Required)

Yes

Do you give permission for the nursery to administer Antihistamene?(Required)

Yes

Do you give permission for the nursery to administer Ibuprofen suspension?(Required)

Yes

Do you give permission for the nursery to administer Paracetamol suspension?(Required)

Yes

Do you give permission for the nursery to use Sudocrem?(Required)

Yes

Do you give permission for the nursery to administer prescribed medications?(Required)

Yes

Have you read and understood the Child Protection policy and the nursery’s legal responsibility for raising any concerns?(Required)

Yes

Does the child have any allergies/special dietary requirements?(Required)

Yes

Please provide details

Has your child conducted a doctor/specialist about allergies/ special dietary requirements?(Required)

Yes

Please provide details of medical advice received

Does your child have medication that needs to be taken in relation to any allergies?(Required)

Yes

Please provide details of medication

Do you wish for the nursery to administer this medication? If yes, you will need to complete a medication form with your nursery manager(Required)

Yes

Please give details of reactions, signs and symptoms your child may show if they have an allergic reaction

Please provide any further information you feel will help the nursery in helping your child's dietary requirements