Hatherleigh Pre-School Information Book

BERE PRIVATE AND CONFIDENTIAL ALSTON

Registration Forms | Bere Alston Preschool Administration Registration Forms

A separate form should be completed for each child. It is important that all parts of this form are completed.

Child’s Full Name: ……………………………………………………………………………………………...

Child’s preferred name: ………………………………………………………………………………………..

Date of Birth:………………………………... Male/Female: …………………………………………………

Ethic Origin: ………………………………… 1st Langauge: …………………………………………………. (voluntary information)

If English is not your child’s first language is this his/her first experience of being in an English speaking environment? Yes/no

Main address of child……………………………………………………….…………………………………….

………………………………………………………………………………………………………………………

…………………………………………….……………………...Post code………………..……………………

Names and Addresses of all previous/current Nurseries, Childminders or Early Years Provisions attended

1. ……………………………………………………………………………………………………………..

…………………………………………………Date attended (from/to): ………………......

2. ……………………………………………………………………………………………………………..

3. ……………………………………………………………………………………………………………..

4. ……………………………………………………………………………………………………………..

Name of Mother/Guardian: Mrs/Miss/Ms……………………………………………………………………….

Previous Name (if any): …………………………………………………… Date of Birth: ………………….

Home Tel No: ...... Mobile Tel No......

Work Tel No: ………………………………... Email address: …………………………………………………

Past addresses (last 5 Years) please use a separate sheet if necessary:

1. ………………………………………………………………………………………………………………

2. ………………………………………………………………………………………………………………

3. ………………………………………………………………………………………………………………

4. ………………………………………………………………………………………………………………

5. ……………………………………………………………………………………………………………… Name of Father/Guardian: Mr …………………………………………………………………………………..

Previous Name (if any): …………………………………………………… Date of Birth: ………………….

Home Tel No: ...... Mobile Tel No......

Work Tel No: ………………………………... Email address: …………………………………………………

Past addresses (last 5 Years) please use a separate sheet if necessary (if different form above):

1. .………………………………………………………………………………………………………………

2. ………………………………………………………………………………………………………………

3. ………………………………………………………………………………………………………………

4. ………………………………………………………………………………………………………………

5. ………………………………………………………………………………………………………………

Do both of the parents/guardians listed above have legal parental responsibility? Yes/No

If ‘No’ who has parental responsibility? ……………………………………………………………………….

Do you, as parents/carers, have any health issues that you would like to inform the pre-school staff about? (This is completely voluntary information and any information that you may choose to disclose will be kept entirely confidential and held with securely with your child’s records. If you would like to discuss this only with the Pre- School Staff please just let us know). Yes/No

Details of other children in family:

Name………………………..…..…….Date of Birth……………………….…..….

Name……………………………..……Date of Birth………………………..…….

Please use the space below to inform us of your first choice of Primary School for your child and their expected year of entry. This is for our information only and is voluntary, however, we do try and work closely with the surrounding schools providing them with an expected number of registrations they may have, so any information would be of a great help.

. 1st Choice of School …………………………………………………..Year of Entry …………………………. Emergency Contacts

Please note:  Other persons authorised to collect your child in case of emergency must be over 16 years of age.  Proof of identity may be required when the persons named below collect your child from the Pre- School. In addition, when asked, they will be required to give the password stated on this form.

EMERGENCY CONTACT 1

Name: Relationship to child:

Address:

Home: Work: Mobile Contact Numbers:

SECURITY PASSWORD:

EMERGENCY CONTACT 2

Address:

SECURITY PASSWORD: EMERGENCY CONTACT 3

Address:

SECURITY PASSWORD:

EMERGENCY CONTACT 4

Address:

SECURITY PASSWORD:

I agree to inform the pre-school of any changes to my emergency contact list

Signature: Print: Date: Agencies involved with your child

Child’s Name: ………………………………………………………………………………………………………………………….

Please let us know which agencies, if any, are involved with your child to further enable us to ensure that your child gets the best continuity of care. Use a separate sheet if necessary

Name and Role Address and telephone

Health visitor

Continence Advisor

Physiotherapist

Occupational therapist

Speech Therapist

I agree to inform the Pre-School of any changes to the information provided

Parent/Carer Signature: Print: Date:

Staff Signature: Print: Date:

Do you have a Social Worker? Yes/No

Name:……………………………………………………………. Location:…………………………………….

Social Worker Tel No:…………………………………………. What is the reason for the involvement of social services with your family?

………………………………………………………………………………………………………………………

STAFF NB. If the child is on the child protection register, make a note here but do not include any details. Ensure these are obtained from the Social Worker named above and keep these securely in the child’s file.

……………………………………………………………………………………………………………………

Name of Doctor ……………………………………………………Doctor’s Tel No…………………………

Are you registered with a dentist? YES/NO

Dentist’s Name: ………………………………………………… Telephone No: ……………………………

Does your child have any specific needs of which you wish the pre-school to be aware e.g. general/food allergies (please give a detailed full list), dietary needs, likes or dislikes, wheelchair access etc.?

Yes/No If yes, please give details below or on a separate sheet of paper

……………………………………………………………………………………………….……………………

…………………………………………………………………………………………………………………….

………………………………………………………………………………………………………………………

Does your child have any of the following: (please tick those that apply):

Asthma Epilepsy Eczema Diabetes Hearing impairment Speech impairment Sight impairment

Has your child received the recommended immunisation programme? Yes/No (please tick to indicate immunisations received)

Hib Rubella Measles MMR or Mumps Tetanus Polio Diptheria

Your child’s religion is: ………………………..………………………………………………………………. (voluntary information) Are there any festivals or special occasions celebrated in your culture that your child will be taking part in that you would like to see acknowledged and celebrated whilst he/she is in our setting?

………………………………………………………………………………………………………………………

Additional Information: Please use the space below to give us any other information you might think would be useful to us to ensure your child’s safety and happiness at our Pre-school. This could include a favourite toy, game, comforter or even if they have any friends already attending the setting. Every little piece of information will ensure we can do our best to ensure that your child will settle quickly with us and feel safe and cared for (please use a separate sheet if necessary).

Please note that the pre-school must be informed of any changes to this information.

Signature of Parent/Guardian………………………………………………Date……………………….…. Parental Permission Required

Part 1: General Parent Consent Form

Child’s Full Name: ………………………………………………………………………………………………..

Some routine activities of the pre-school may involve brief local outings E.g. nature walks etc. These outings may be decided on during a pre-school session without prior notice. For your child to take part in these activities you must give us your permission to involve your child(ren). We also need permission for various other activities which are outlined below.

The following adults have legal parental responsibility for the above named child (please print names clearly):

Adult Name: Relationship:

Please circle either YES or NO in all instances:

I give consent for my child’s photograph to be taken during outings or in the setting Yes / No and displayed or as a record of our observations in your child’s Learning Journey.

I give consent for my child to have their photograph taken in a group situation. Yes / No

I give consent for my child to have their photograph taken for the use of advertising on Yes / No the pre-school web site and pre-school literature as required, as well as for use in local papers.

I give consent for my child being videoed for observation purposes or during Yes / No performances or outings.

I give consent for my child’s work being displayed. Yes / No

I give my consent for my child’s work being displayed and to be labelled with their first Yes / No name.

I give consent for my child to have their face painted if they wish when these activities Yes / No are arranged.

I give consent to my child going out on local visits or outings and understand that this Yes / No will be in line with the preschool’s Educational Visits and Outings Policy.

I give consent for my child to travel to outings in Staff cars and other named driver’s Yes / No cars that have full comprehensive insurance.

I give consent for basic First Aid to be carried out by a trained First Aider if necessary. Yes / No

I give consent for pre-school staff to apply hypoallergenic plasters on my child and/or Yes / No use alcohol free antiseptic wipes should the need arise.

I give consent for my child being transported to hospital in an emergency. Yes / No

I give consent for my child receiving emergency treatment at hospital. Yes / No

Please Note:  Written consent must be received by the parents that requests an alternative food/snack be prepared if your child has a food allergy/intolerance/consistent dislike of what is on offer.  We are unable to heat any food so please do not give your child lunch that requires this.  Forms for the administration of prescribed medicines must be filled in by the parent before our Staff will administer any medication. These detail type, dosage and frequency of said medicine.

Comments/additional information:

I have read and understood the Policies and Procedures. I understand that a full set of Policies can be provided on request; that they are Yes / No updated regularly and that there is a copy on display in the setting which can be read and referenced on site.

I understand that the provision’s Policies and Procedures form part of my legal Yes / No contract and responsibility between the Pre-school and me.

Signed (parent or carer with legal responsibility for the above named child) Date Part 2: Sun Cream Consent Form

Child’s Full Name: …………………………………………………………………………………………………………….

ALL PARENTS: Please tick the statement that applies to you:

I will be responsible for the application of sun cream during hot weather before starting the preschool session and I give permission for my child to play outdoors without further sun cream application by the preschool staff.

I give permission for staff members to apply sun cream which is provided should my child need a further application when attending on a full day session and I understand that if permission is not given and an alternative not supplied, my child may have to remain indoors in hot weather.

I understand that my child may not be able to play outside if I do not apply sun cream before each session that my child attends.

I understand that my child should come to preschool with a sun hat to use in outdoor play in hot weather.

Comments/additional information:

Signature of parent/carer (with legal parental responsibility for the above named child).

Date: Part 3: Parental agreement to regularly administer medicine

The Pre-School Staff will not administer medication to your child unless this form is completed. All medicines must be prescribed by your child’s doctor. Our staff will not administer any other medicine to your child through the course of the day. Our procedure for administering medicine is found in our Health & Safety Policy, please ensure that you have read and understood our policies and procedures which are in place to protect both your child and the staff.

Please Note:  All medicines must be in the original container as dispensed by the pharmacy without exception. Staff will not administer any medicine from any other container.

 If more than one medicine is to be administered a separate form should be completed for each one.

Child’s full name:

Full name of prescribed medicine and strength (including any homeopathic medicine):

Full name of prescribed lotion and strength:

Please describe the condition the medicine is being used for e.g. Diuretic, heart, laxative etc.

Dosage to be given and at what time(s) or frequency?

Please describe the method by which the medicine should be administered:

Are there any side effects or special precautions that our staff should be aware of?

To be initiated by your child’s key worker:

Agreed Review Date: …………………………………………………………………………………………………………………………………….

Please note that a new form should be filled in after a maximum of 4 weeks has passed and the review date should not be longer than 4 weeks after the previous review date or registration.  All information is, to the best of my knowledge, accurate at the time of writing and I give consent to Pre- School staff administering medicine in accordance with the Pre-School’s Policies and Procedures which I have read and understood.

 I will inform the staff immediately, if there is any change in the dosage or frequency of the medicine or if the medicine is stopped.

 I understand that it is very important that I inform the staff on arrival at a session if I have given my child any medication not prescribed by a doctor E.g. Paracetemol/Ibuprofen.

 I will inform the staff if my child is on any prescribed medication E.g. Antibiotics/laxatives etc. even if the medicine is not to be administered during their time at the Pre-School, to allow for a better understanding of what may be affecting my child during their session.

 I will not leave any medicine in my child’s bag but will ensure that all medicines are given to the staff for safe storage. (This includes, but is not exhaustive, any adult headache tablets etc and inhalers). I understand that leaving medicine in an area that can be accessed by children undermines the safeguarding of mine and other children at the Pre-School.

Staff Signature: Print: Date: Record of medication administered

Child’s full name:……………………………………………………………………………………………………………………………………………………………………………………….

Staff Parent/Carer Date Time Name of medicine Dose counter Signature given Reactions? Staff signature Print name signatory

Part 4: Providing Intimate Care

At our Pre-School we aim to provide the highest level of Safeguarding to your children and we aim to ensure our procedures are open to the highest level of inspection. Part of the way we do this is by seeking your permission to provide the appropriate level of intimate care to support your child in their development. E.g. changing soiled clothing, nappies, washing and toileting etc. We will not carry out any intimate care without this completed form.

Child’s Full Name

Male/Female: Date of Birth:

Parent/Carers Name

 I give permission to the Pre-School to provide appropriate intimate care support to my child e.g. changing soiled clothing, nappies, washing and toileting.

 I will advise the Pre-School staff of any medical complaint my child may have which affects issues of intimate care.

Print Name Signature:

Relationship to child: Date:

Toilet Management Plan (to be completed with staff on registration)

Child’s name…………………………………………………………………………………………………………………………

Name(s) of staff involved: …………………………………………………………………………………………………………

Area of need:

Equipment required:

Location of suitable toilet facilities:………………………………………………......

Support required…………………………………………………………………………………………………………………

Frequency of support………………………………………………………………………………………………………………

Working towards Independence

Child will try to Staff will do Target Achieved

Agreed Review Date: ……………………………………………………………………………………………………………………………………..

Staff Signature: Print: Date:

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Part 5: Sharing Information

We recognise that parents/carers have a right to know that information they share will be regarded as confidential as well as be informed about the circumstances and reasons, when we are obliged to share information. We are obliged to share confidential information without authorisation from the person who provided it or to whom it relates if it is in the public interest.

That is when:  It is to prevent a crime from being committed or intervene where one may have been  To prevent harm to a child or adult  Not sharing it could be worse than the outcome of having shared it.

The decision should never be made as an individual, but with the back-up of management and the governing body. The three critical criteria are:  Where there is evidence that the child is suffering, or is at risk of suffering, significant harm.  Where there is reasonable cause to believe that a child may be suffering or at risk of suffering significant harm.  To prevent significant harm arising to children and young people or serious harm to adults, including the prevention, detection and prosecution of serious crime.

Child’s Full Name

Male/Female: Date of Birth:

Parent/Carers Name

 I give permission for the preschool to share information about my child to outside agencies when it is in the best interests of my child, particularly information about any additional needs my child may have or to pass on child development summaries to the next provider or on transition to primary school.

 I understand that there may be circumstances when my consent may not be sought, or my refusal to give consent may be overridden particularly if there is a safeguarding issue which needs to be addressed or where there is a statutory duty or court order to share information

 I understand that a record will be kept of all instances where this is the case.

Print Name Signature:

Relationship to child: Date:

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Office Use Only

Expected Start Date: Actual Start Date:

Child’s Key Worker:

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