Which nursery are you interested in registering in?*
EitherSalehurstHurst Green
Thank you for considering Puddle Ducks Nursery for your child’s early years education. Please complete the form below to register your child with us.
Child’s Full Name*
Date of Birth*
Birth Cert / Valid Passport Scan (max 15mb)
Gender*
MaleFemale
Home Address*
Primary Language(s) Spoken at Home*
Does your child currently attend another childcare setting?* YesNo
If so, what is the name of the setting?
Do you give us permission to contact this setting? YesNo
Has your child attended a childcare setting in the past?* YesNo
If so, what was the name of the setting?
Full Name*
Relationship to Child*
MotherFatherGuardian Other:
Phone Number*
Email Address*
Alternative Contact Number
Address (if different from child)
Do you have parental responsibility?*
YesNo
Full Name
Relationship to Child
Phone Number
Email Address
Do you have parental responsibility?
Name
Can we contact this person in case of emergency?
Yes
Special Password for Collection
(we’ll ask for this password if your child is being picked up by someone new)
Does your child have any medical conditions?* YesNo
If yes please specify:
Does your child have any allergies or dietary requirements?* YesNo
Doctor’s Name
Doctor’s Address
Doctor’s Phone Number
We provide breakfast and snacks for free, but you’ll need to provide your own packed lunch for a morning session, and tea for an afternoon session. Or you can order from our catering partner for lunch and tea. View more food information here.
What would be your preference?*
(1) We'll provide our own lunch and tea(2) We'd like to order your lunch and tea available
Information will be used to support your child and will be kept confidential.
Is your child a looked after child? (a child in care)* YesNo
Has your child ever spent time in care?* YesNo
Is your child known to children’s social care or has a social worker?* YesNo
Does your child have any special educational needs, disabilities, or other support requirements?* YesNo
If yes, please specify:
Please tell us about your child’s routine, interests, personality, and anything important to help us care for them:*
Does your child have a preferred comfort item/s?* YesNo
If yes, please give a brief description of their comfort item:
Preferred start date*:
Morning session 8am-1pm
Afternoon session 1pm-6pm
Monday
Tuesday
Wednesday
Thursday
Friday
***If you are applying for 15 hours funding this is equal to 11.25 hours stretched as we are operating 51 weeks per year.
Are you planning to apply for funding?* YesNo
15 hours (11.25 hours stretched)30 hours (22.5 hours stretched)
Funding Code (if applicable)
Parent 1 National Insurance Number
Parent 2 National Insurance Number
Early Years Pupil Premium (EYPP) is extra funding… (see website for more info).
I think my child is or may be entitled to EYPP and I give permission for you to check Yes
Parent Date of Birth (Required if checking EYPP)
Do you give permission for Tapestry?* YesNo
Do you give permission for group photos?* YesNo
Are we permitted to administer Calpol?* YesNo
Are we permitted to apply Sudocrem?* YesNo
Are we permitted to apply sun cream?* YesNo
Are we permitted to take your child on nature walks?* YesNo
I confirm information is correct.
I agree to policies and procedures.
I give permission for basic first aid.
Parent/Guardian 1 Signature (Name)*
Date*
