About your child

Legal First Name

Middle Name(s)

Legal Surname

Name he/she is known by, if different


Date of Birth

Collection password
(For and adult we dont recognise whom you ask to pick up your child)

Child's home address


Home Telephone

Parent / Carer Details

First Parent / Carer
Full Name

Relationship to child

Daytime contact number

Mobile Telephone

email address

Lives at the child's home address?YesNo

Home address and postcode

Second Parent / Carer
Full Name

Relationship to child

Daytime contact number

Mobile Telephone

email address

Lives at the child's home address?YesNo

Home address and postcode

Who has legal Parental responsibility?

Please see the official definition of parental responsibility to ensure you have answered this correctly.


Other Significant Contacts

Use this section to tell us about other adults who may act on your behalf.

Name Relationship to child Daytime tel Mobile tel Can they collect your child? Can they take parental decisions in an emergency?

If you wish to add any more adults, please do so using the additional information section at the end of the form.

Health Questions

Doctors Name



Can we give your child first aid / emergency medical treatment?

You have told us that we may not administer first aid in any circumstances. We will need to discuss your wishes further before we finalise your registration, to enusre we are able to care for your child properly.

Does your child have any non food allergies

Does your child have any illness or condition we must manage in order to care for them properly?

Is your child on any long term medication?

Does your child have any special needs

Please provide us a description of your childs situation, including symptoms, severity and treatment as approprite. If you feel this space is not suitable or appropriate to the situatuion, please let us know below and we will arrange an appropriate discussion.


Does your child have any food allergies?

Is your child a vegetarian?

Does your child have any special dietary requirements?

Please provide more information about any questions you have answered yes to, and add any other dietary notes you wish us to take account of.

Whilst we do not provide routine meals, cookery activities and special celerations will involve your child touching and eating food supplied by us. It is important that we are able to do this safely based on the information you provide


Can we take photos of your child for internal use?
These are an important part of your childs developmental record at pre-school

Can we display these photos around the site?
Generally this means putting up photos around Teatimers where other families and prospective parents will see them. If we wanted to use them for a wider purpose, we would ask for your specific permission.

Can we use these photos on our facebook page?
(our facebook page is restricted to Teatimers families only)

Can we take your child on local trips on foot?
This means things like a walk to a nearby park on a nice day, a nature walk or a trip to post a letter.

Are there any specific named adults who may not have access to your children?
(If so, we will contact you separately to work out appropriate arrangements

Can Bucks CC and Teatimers recheck your funding eligibility using the systems provided by the Government?
Eligibility for funding has to be rechecked 6 times a year. We dont get to see any personal information, just notification that you are still eligible.

Any further comments regarding permissions?

Languages Spoken

Main language your child understands

Main language your child speaks

Other Languages spoken at home


For local authority audit purposes, please choose the appropriate ethnicity code for your child.

Additional information

Please tell us anything relevant about your child that will help us to care for them. For example
- things that will upset them and calm them down
- favourite activities
- Accident prone / tendency to run off

Privacy and data protection

I understand that Teatimers needs to hold personal information about my child and family for the purposes of keeping them safe and tracking their development during their time at Pre-School. I have read the privacy notice and consent to Teatimers processing information for the purposes it states.


Signed Date