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Registration Form

To register your child we need some information

Name of Child:
Date of Birth: Sex: Boy / Girl

Proposed Start date: Proposed Finish Date:

Your Name: Relationship to child:

Your Partners Name: Relationship to child:

Post Code:
Home Tel: Mobile Tel:

Childs Doctor: Work Tel:

Doctors Address:
Post Code:
Childs health visitor: Tel:
Childs social worker: Tel:

Employer Information:
Your Company: Work Tel:
Company Address:
Post Code:
Your partners company: Work Tel:
Company Address:
Post code:

Emergency Contact details; (please give two contacts)

Name: Relationship to child:
Name: Relationship to child:

About your families; (please describe your cultural background)

Ethnicity Languages spoken at home:
About your child; (please let us know, in confidence, about your childs needs)
Special needs or Disabilities:
Special dietary needs/alergies/medication required:

Place in Family: (e.g. eldest of three, or fourth of fifth)

What session would you like? (These will be confirmed in writing)

Please circle:
Monday PM
Tuesday PM
Wednesday PM
Thursday PM
Friday PM
Harvard Park Pre-School
Terms and Conditions

I agree to be prompt when collecting my child

I agree to sign any agreement needed
I agree to pay my fees weekly in advance (not arrears)
I agree to pay four weeks fees if I decide to leave
I agree to give four week notice in writing if leaving
I agree to contact the pre- school if my child is absent
I agree to inform the staff of any injuries that occurred at home or outside school
I agree to you informing me of my childs achievements or any concerns
I agree to abide by the no jewellery policy
I agree to inform the pre school of any changes in my family circumstance that may affect
my child
I agree to support the pre-school in fund raising events
I agree to support the pre-school in donations of 1 to 2 pieces of fruit or vegetables each
I agree to pay a late collection fee of 5. 00 for every 10 min past normal time
I agree to not parking in the school grounds
I agree to shut doors and gates behind me at all times
I agree to not smoke on school grounds
I agree once I have left the building with my child I will not return to the premises and not
enter with out a member of staff
I understand that if I break the terms/ conditions or health and safety policy I will be given a
verbal warning then written and asked to leave
I understand that as soon as I walk through the door and on the premises my child be
comes my responsibility. The adult at the door will continue to give security to those
children without parents
I understand I must not bring my child in to pre-school if he/she has been unwell or running
a temperature in the last 24 hours
I agree to answer fully any questions set out on the registration and in the operational
prospectus and up date any changes
I agree to pay full fees for absents / sickness
I agree to pay a registration fee (this is non-refundable)
Harvard park Pre-school reserves the right to refuse or withdraw a place for any child if we
believe such actions is in the best interest, safety and security of that child or other children
attending the pre-school. Your childs place can also be withdrawn if you fail to pay the
correct fees
I understand if I default on payment the pre-school will try and make a special arrangement
to pay the debt this fails we will authorize a third party such as debt collection agent or a
solicitor to act on our behalf in recovery of the debt, you will be informed in writing before
we disclose your details to them

Parents Signature Date