Pre-School registration This form is used to provide us with detailed information, once you have been offered a place. If you haven't yet applied for a place, please use our application form instead. Please provide the registration details below About your child Gender MaleFemale Date of Birth (For an adult we don't recognise) Parent / Carer Details First Parent / Carer Lives at the child's home address?YesNo Home address and postcode Second Parent / Carer 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 if needed. First Adult Can they collect your child? —Please choose an option—YesNo Can they take parental decisions in an emergency? —Please choose an option—YesNo Second Adult Can they collect your child? —Please choose an option—YesNo Can they take parental decisions in an emergency? —Please choose an option—YesNo Third Adult Can they collect your child? —Please choose an option—YesNo Can they take parental decisions in an emergency? —Please choose an option—YesNo If you wish to add any more adults, please do so using the additional information section at the end of the form. Doctor Address The Doctors House Victoria Road Marlow SL7 1DN Telephone Health Questions Can we give your child first aid / emergency medical treatment? YesNo 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? YesNo Does your child have any illness or condition we must manage in order to care for them properly? YesNo Is your child on any long term medication? YesNo Does your child have any special needs? YesNo Please provide us a description of your child's situation, including symptoms, severity and treatment as appropriate. If you feel this space is not suitable or appropriate to the situation, please let us know below and we will arrange an appropriate discussion. Diet Does your child have any food allergies? YesNo Is your child a vegetarian? YesNo Does your child have any special dietary requirements? YesNo 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. Even if you do not expect your child to eat whilst at Teatimers, we will always be preparing food whilst they are in the building. It is important we know anything relevant about food related matters and allergies. Permissions Can we take photos of your child for internal use? Photos are a great record when your child has done something special. YesNo 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. YesNo Can we use these photos on our facebook page? (our facebook page is restricted to Teatimers families only) YesNo 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. It applies mostly to Holiday club. YesNo 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 YesNo Can Teatimers and Bucks CC check your funding eligibility using systems provided by the government? It is necessary to record and input limited personal information onto a government website (name, eligibility code and NI number) in order to check eligibility for additional funding. It will only happen if you claim for 30 hour funding. YesNo Any further comments regarding permissions? Languages Spoken Ethnicity For local authority audit purposes, please choose the appropriate ethnicity code for your child. —Please choose an option—WBRI White, BritishWIRI White, IrishWIRT Traveller of Irish HeritageWROM Gypsy/RomaWOTH White, any other White BackgroundMWBC Mixed, White and Black CaribbeanMWBA Mixed, White and Black AfricanMWAS Mixed,White and AsianMOTH Mixed, any other mixed backgroundAPKN Asian or Asian British, PakistaniABAN Asian or Asian British, BangladeshiAOTH Asian or Asian British, any other Asian backgroundBCRB Black or Black British, CaribbeanBACFR Black or Black British, AfricanBOTH Black or Black British, any other Black backgroundCHNE ChineseOOTH Any other ethnic backgroundREFU Did not wish to be recorded 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 Declaration I agree to adhere to all Teatimers policies, procedures term and conditions, and to keep Teatimers updated with any changes in my family / child’s details. I understand that Teatimers will hold personal information about my child and family for the purposes of keeping them safe, planning and administration. This information will be in electronic, written and photographic form. Signed Signed Date
