Childs Full Name: Mobile Number

Buckles & Bows Pre-School Nursery Ongar Hill Addlestone Surrey KT15 1BP Tel: 01932 827556 E-mail: [email protected]

Childs Full Name: Mobile Number:

Sex: M F Home Number:

D.O.B: Email Address:

Address:

Nationality: Religion:

Home Language: Languages spoken By child:

Does your child have any special educational needs/disabilities? NO YES (please give details, including support received i.e. speech therapist, occupational therapist or other)

Does your child have any specific dietary requirements including allergies or preferences (i.e. gluten or dairy free, vegan or vegetarian?)

Does your child have any medical requirements? (i.e. inhaler, epipen)

* I/We wish to guarantee a place at Buckles & Bows Pre-School Nursery and enclose £50.

Buckles & Bows Pre-School Nursery Registered Charity No. 283723 Buckles & Bows Pre-School Nursery Ongar Hill Addlestone Surrey KT15 1BP Tel: 01932 827556 E-mail: [email protected]

*I/We wish to go on the waiting list and understand that, if offered, I/we will have to pay £50 to confirm and guarantee the place. Please indicate if you’d be interested in joining the committee ……………………

From ………………………… (Date) (*Delete where applicable)

If we are offered a place which we no longer require, we will inform the pre-school as soon as possible. We understand that the £50 consists of a £25 non refundable Administration Fee, plus a £25 deposit which is held until the last invoice. Should we cancel the place prior to starting at Buckles and Bows we understand that we will forfeit the full £50 deposit. Once our child has started at Buckles and Bows if we fail to give 6 weeks written notice of withdrawing our child, we also understand that we forfeit this £25 refund.

Signature of parent …………………………………………………………………………….. Date………………………………………. Please make cheques payable to ‘Buckles & Bows Pre-School Nursery’ and return with form to: Lottie Saunders at the nursery tel: 07733 320950 ------ADMISSION TO BUCKLES & BOWS PRESCHOOL NURSERY ……………………………………………………………………………………………………………….. (Child’s name)

* A place will be available from ……………………………………………………… (Date)

* Your details are on the waiting list. We will notify you if a place becomes free.

Signed for the pre-school ……………………………… Name ………………………….. ………………… Date ……………………….

Buckles & Bows Pre-School Nursery Registered Charity No. 283723