<p> REGISTRATION FORM</p><p>CHILD’S DETAILS</p><p>CHILD’S SURNAME: FIRST NAMES IN FULL:</p><p>DATE OF BIRTH: AGE: BOY/GIRL* RELIGION:</p><p>ETHNIC ORIGIN: LANGUAGE USED AT HOME: CHILD’S ADDRESS:</p><p>POST CODE: HOME TELEPHONE NUMBER:</p><p>PARENT’S DETAILS </p><p>WHO HAS PARENTAL RESPONSIBILITY? MOTHER FATHER BOTH *PLEASE CIRCLE</p><p>MOTHER/GUARDIAN (SURNAME/FIRST NAME):MRS/MS/MISS PLACE OF WORK /CONTACT HOME TELEPHONE: NO MOBILE TELEPHONE EMAIL</p><p>FATHER/GUARDIAN (SURNAME/FIRST NAME): PLACE OF WORK /CONTACT HOME TELEPHONE : NO MOBILE TELEPHONE EMAIL</p><p>MOTHERS NI NUMBER: FATHER’S NI NUMBER:</p><p>MEDICAL DETAILS</p><p>DOCTOR’S NAME: TELEPHONE NO:</p><p>SURGERY ADDRESS:</p><p>KNOWN ALLERGIES: SPECIAL DIETARY REQUIREMENTS: MEDICATION /ANY OTHER INFORMATION:</p><p>CARE REQUIRED PLEASE TICK SESSIONS REQUIRED: BARN HILL CIRCLE NURSERY REQUIRED WOOD NB: IF YOU REQUIRE A FULL DAY SESSION (8.00AM – 6.00PM) PLEASE TICK BOTH BOXES. MORNING (8.00AM-1.00PM) AFTERNOON (1.00PM-6.00PM) DAY INCLUDES MID MORNING SNACK & LUNCH INCLUDES TEA MONDAY: TUESDAY: WEDNESDAY: THURSDAY: FRIDAY: REQUIRED STARTING DATE: I/we wish to register my/our child for the above sessions. Upon submission of a completed registration form and request for a place, the nursery will make an offer in writing to the parent/guardian. A place will be considered booked once the offer by the nursery has been accepted by the parent/guardian in writing and a registration fee of £25 is paid by the parent/guardian to the nursery. In addition to this, a deposit of £80 will be required. This will be refunded when the child leaves the nursery providing all terms and conditions have been complied with. The deposit is non-refundable if the child does not start at the nursery. Written acceptance by the parent/guardian of the nursery’s offer and payment of the deposit deems the parent/guardian to be bound by the terms and conditions enclosed. SIGNED: DATE PARENT/GUARDIAN : DATE PARENT/GUARDIAN SIGNED: :</p><p>Chauntry Childcare Ltd. Reg.No: 5342453 Reg. Office: 20 Chauntry Road, Maidenhead SL6 1TS</p>