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Nursery New Starter Admission Form
Required *
Before your child starts please bring a form of identification for your child to be verified by a
member of admin staff i.e. passport/birth certificate.
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* Indicates required question
Your answer
Child's LEGAL SURNAME (if applicable)
Your answer
Child's MIDDLE NAME(s) (if applicable):
Your answer
Child's FORENAME *
Your answer
Child's PREFERRED FORENAME (e.g. Benjamin but goes by Ben)
Your answer
Child's Date of Birth *
MM
/
DD
/
YYYY
Home Address incl, Post Code *
Your answer
Child's Gender *
Your answer
Does your child have any siblings in the school? If so, please list their names below.
Your answer
Emergency Contact 1/Parent 1 - Full Name *
Your answer
Emergency Contact 1/Parent 1 - Relationship *
Choose
Mother
Father
Step-parent
Grandparent
Other relative
Other contact
Emergency Contact 1/Parent 1 - Does this person have parental responsibility? *
Choose
Yes
No
I would like to give more information at the end of this form.
Emergency Contact 1/Parent 1 - Address including Post Code *
Your answer
Emergency Contact 1/Parent 1 - Contact telephone numbers (please state whether mobile/work/home etc.) *
Your answer
Emergency Contact 1/Parent 1 - Contact Email Address *
Your answer
Emergency Contact 2/Parent 2 - Full Name
Your answer
Emergency Contact 2/Parent 2 - Relationship
Choose
Mother
Father
Step parent
Grandparent
Other relative
Other contact
Emergency Contact 2/Parent 2 - Does this person have parental responsibility?
Choose
Yes
No
I would like to give more information at the end of the form
Emergency Contact 2/Parent 2 - Address incl. Post Code
Your answer
Emergency Contact 2/Parent 2 - Contact telephone numbers (please state whether mobile/work/home etc.)
Your answer
Emergency Contact 2/Parent 2 - Contact Email Address
Your answer
Emergency Contact 3 - Full Name
Your answer
Emergency Contact 3 - Relationship
Choose
Mother
Father
Step parent
Grandparent
Other relative
Other
Emergency Contact 3 - Does this person have parental responsibility?
Choose
Yes
No
I would like to give more information at the end of this form.
Emergency Contact 3 - Address including Post Code
Your answer
Emergency Contact 3 - Contact telephone numbers (please state whether mobile/work/home etc.)
Your answer
Emergency Contact 4 - Full Name
Your answer
Emergency Contact 4 - Relationship
Choose
Mother
Father
Step parent
Grandparent
Other relative
Other
Emergency Contact 4 - Does this person have parental responsibility?
Choose
Yes
No
I would like to give more information at the end of the form.
Emergency Contact 4 - Address including Post Code
Your answer
Emergency Contact 4 - Contact telephone numbers (please state whether mobile/work/home etc.)
Your answer
Please use this space to enter any other relevant information regarding your child's emergency contacts (e.g. one parent works away and is therefore unlikely to be able to collect the child if they are unwell at school)
Your answer
Please list any previous schools or nurseries attended. (If your child has not attended a nursery or school please write 'none') *
Your answer
Medical Practice Your Child is Registered At *
Your answer
Medical Practice Address *
Your answer
Medical Practice Telephone Number *
Your answer
Child's NHS Number (if known)
Your answer
Any relevant medical/dietary/allergy information? (Please type 'none' if your child does not have any needs/requirements.) *
Your answer
Child's Ethnicity *
Your answer
Child's Nationality *
Your answer
Child's Home Language *
Your answer
Child's First Language *
Your answer
Child's Religion *
Your answer
Please tick any/all boxes that apply...
we are a services family
our child is classed as 'looked after' or legally in care
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Has your child attended a nursery/setting before? (If yes, please provide details)
*
Your answer
Does you have a social worker? (If yes, please provide a name and contact telephone number.)
*
Your answer
Is your child toilet trained?
*
Yes
No
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