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Registration Form
We can enrol your child onto our waiting list from age 2 to start when they reach 2 years 6 months and they can continue with us until they go to school. You can pick the days to attend, term time Mon-Fri 9.31-11.30am
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* Indicates required question
Email
*
Your email
Child's Name
*
Your answer
Child's Address
*
Your answer
Child's Date of Birth
*
MM
/
DD
/
YYYY
All Parent/Carer's Names & Phone No's
*
Your answer
Name of other children in the family
Your answer
Emergency Contact Name & Number
Your answer
Relevant information staff should be aware of (all information is completely confidential)
*
Recurring illness
Medical disorder
Dietary requirements i.e Halal
Allergies
Speech delays
None
Other:
Day(s) requested (£8 per day)
*
Monday
Tuesday
Wednesday
Thursday
Friday
Required
Child's likes
*
Your answer
Child's dislikes
*
Your answer
I give consent for emergency medical assistance to be sought for my child if I cannot be contacted
*
Yes
No
Would you be willing to sit on the Committee? As a charity we cannot operate without a parent committee & constantly need new members due to high turnover of children. We only meet 4 times per year.
*
Yes
No
Maybe, I'd like more information
Would you be able to help out at Playgroup if required as relief staff?
*
Yes
No
I give permission for my child’s photo to be displayed within Playgroup and posted on our closed Facebook Group containing current parents only.
*
Yes
No
I have read Polmont Playgroup’s welcome information booklet (available on www.polmontplaygroup.org) and agree to pay fees monthly in advance and to give notice of leaving 2 months in advance.
*
Yes
No
Parents/carers Applicant Name
*
Your answer
Date of application
*
MM
/
DD
/
YYYY
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