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Reception Entry Form 2021-2022
Please complete and return your child’s entry form no later than Friday 25th June 2021. .
Current Nursery parents will have completed one of these previously so please take a look and update with any changes.
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* Indicates required question
Email
*
Your email
Child's Name:
*
Your answer
Known as:
*
Your answer
Date of Birth:
*
MM
/
DD
/
YYYY
Born in the UK?
*
Choose
Yes
No
Sibling names and ages:
*
Your answer
Occupation - Mother:
*
Your answer
Occupation - Father:
*
Your answer
Language/s spoken by child:
*
Your answer
Language/s spoken by mother:
*
Your answer
Language/s spoken by father:
*
Your answer
Language/s spoken to child by mother:
*
Your answer
Language/s spoken to child by father:
*
Your answer
Does your child use the toilet?
*
Independently
With adult support
Have they ever had contact with other health professionals / health services, e.g. Hearing or visual impairment services, speech and language therapist, pediatrician etc NO/YES
*
Yes
No
Required
Have they ever had contact with other health professionals / health services, e.g. Hearing or visual impairment services, speech and language therapist, pediatrician. If YES please provide details below
*
Your answer
Do they have current / recent medical needs? E.g. Asthma, Food allergies, Eczema, Reaccurring ear infections etc: YES / NO
*
Yes
No
Required
Do they have current / recent medical needs? E.g. Asthma, Food allergies, Eczema, Reoccurring ear infections etc: If yes please provide details below
*
Your answer
How are they separating from you? Fine, upset initially, very distressed?
*
Your answer
Favourite Activities / Games:
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Your answer
Favourite Toy / Character:
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Your answer
Is your child willing to try new foods?
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Yes
No
Sometimes
Can your child use a knife and fork independently?
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Yes
No
Sometimes
Can your child dress and undress independently?
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Yes
No
Sometimes
Can your child put on and take off their coat independently?
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Yes
No
Sometimes
Does your child know any other children who will be attending Reception?: Yes /No
*
Yes
No
Please note any other details you would like us to know about your child or any questions that you would like to ask?
*
Your answer
A copy of your responses will be emailed to the address you provided.
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