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Child Registration Form

Step 1 :Child’s Details

Date Of Birth :

Gender :


Home Address:

Step 2 : Parent/Carer 1 with whom the child lives

Does this person have parental responsibility?

Contact Details:

Step 3 : Parent/Carer 2 with whom the child lives (if applicable)

Does this person have parental responsibility?

Contact Details:

Step 4 :Any parent with whom the child does not live:

Home Address

Contact Details

Does this parent have legal access to the child?

Step 5: Emergency Contact (other than above):

Contact Details

Step 6: Additional Information:

People who may collect your child

Child’s School:

Health Visitor:

Child’s Doctor:

Surgery:

Phone:

Does your child have:

On-going health problems?

Special needs that staff should be aware of?

Allergies or special dietary requirements?

A child protection plan?

A CAF Plan (Common Assessment Framework)

First Aid Treatment:

I give permission for my child to receive first aid treatment from appropriately qualified staff:

Is your child allergic to plasters?

I give permission for my child to be taken to hospital by ambulance and to be given treatment by Paramedics / hospital staff in an emergency:

Observations:

I give permission for observations to be made on my child while in the setting for the purpose of activity planning.

Photographs & Videos:

I give permission for general photographs and video recordings to be taken of my child for the following purposes:

Displays within the setting :

Children’s learning record files

Local paper / news letters

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