Nutkins Registration Pack 2015

Registration Form
Name of child:
Male/Female
Date of birth:
DD/MM/YYYY
Address (including postcode):
Postcode:
Parents/Guardians name/s and Telephone No:
Email Address:
Who has parental responsibility for your child?
Who is authorised to pick up your child ?
Any other Contact names or numbers in the
event of us being unable to contact any of the
above ?
Name, Address and Tel No of Doctor :
Immunisations up to date:
Yes/No
Any other information including Dietary, Medical

and Allergies:
Language spoken at home:
Religion/Belief:
Ethnicity:
Any others professionals involved with your
family? (e.g. social worker, health visitor) etc.
I, the parent/guardian of the child named above give my permission for the child to attend hospital
with a member of Nutkins staff in an emergency at the playgroup leaders discretion. I have read,
understood and agree to the preschool policies and procedures.
Parent/Guardian signature..........................................................................................Date..................................
Any other information or concerns (Please use other side if required)
Staff Use
Date of Birth Verified:
yes/no
[email protected]
Start Date :
(very important)
07595 603498
This Parental Declaration will set out the hours and patterns of access to the Funding that the
parent and provider have agreed to and will be valid the entire time the child attends the setting.
The notice period to leave the setting is 4 weeks. Failure to adhere to this may result in
the repayment of your funding or it being withdrawn at a new Provider.
Please complete in BLOCK CAPITALS
Child/rens details to be completed by the Parent / Carer
First Name: _________________________

Date of Birth: __/__/__
Surname: ______________________________
Gender: Male / Female (delete as appropriate)
Has the childs DOB been verified (i.e. birth certificate/medical card): Yes / No (delete as appropriate)
Address: _____________________________________________________________________
Postcode: __________________________
Home Tel: __________________________
Mobile:_________________________________
Maximum entitlement remains at 15 hours per week if claiming EEE / 2YOO at 2 Providers
(max 570 hour/year if over more than 38 weeks).
1 ) Setting Name
Date Registered
Date Started
Days / Hours Attending

per week
Hours Claiming
per term
2 ) Setting Name
Date Registered
Date Started
Days / Hours Attending

per week
Hours Claiming
per term
Does your child attend a provision in a borough other than Havering: Yes / No
If yes please complete the name of the Provider:
1 ) Setting Name
Borough Name
Date
Registered
Date
Started
Days/Hours
Attending
Hours
Claiming
Parental Declaration
By signing this declaration, I agree with the following conditions of the funding:
I understand that the 15 hours free entitlement must be free at the point of delivery and that I
cannot be charged for this in advance.
I have received a detailed parent guide from the Provider and have been advised of additional
services available for my child and I understand that I will have to pay fees for these services.
I understand that I have to provide notice, in line with the Provider terms and conditions, in order
for the funding to follow my child if they move to another setting during the funded term.
If I do not adhere to the notice period as stated on this agreement I agree that I may be liable for
the cost of the funding at this or any other provider.
I understand that if my child leaves the Provider they will complete a Funding Transfer Form.
My child is not registered to claim more than 15 hours funding.
I have not been charged a Registration / Administration Fee in relation to this place.
Signature Parent / Carer / Guardian:
Name Parent / Carer / Guardian:
Relationship to Child:
Date: ___/___/___
Provider use:
Date of review:
Name:
Signed:
Date: ___/___/___
New Child Registration Form
Complete in BLOCK CAPITALS using one form per child and record the childs details as they appear on the birth
certificate.
Proof of address should be provided for the applying parent
Please ensure that an ethnicity code has been selected. Should a parent / carer not wish to provide a code, this must be
entered on to the form as REFU (Did not wish to be recorded).
Once completed a copy of this form should be made available to the parent / carer.
Please ensure you parent has read and understood the declaration before signing this form.
Provider Name
Registration date
Start Date at setting
The child below may

be eligible for (please
tick)
EEE Two Year Old Funding
EEE Three Year Old

Funding
Early Years Pupil Premium

for three and four year olds
Child details
First Name
Surname
Date of birth
Date
Month
Gender (please tick)

Year
Male
Female
Home Address and postcode
First /Home Language Spoken

Parental Funding Declaration Form in
place? (please refer to EEE Guidance for
further information)
Yes
No
Parent / carer details
Parents claiming the EEE for two year olds and the Early Years Pupil Premium must also provide their Date of Birth*
and National Insurance Number (NINO) or National Asylum Seekers (NAS) Number**.
First Name
Surname
Contact number
Email
address
Home Address and postcode (if different from above)
Proof of address
seen
Council Tax bill / Gas Bill / Electricity Bill / Water Bill
Date of Birth*
NINO/NAS**
number
Ethnicity Codes
The Ethnicity Codes provided are classified by the Department for Education (DfE) for Schools and Early Years provisions and
will be used to identify take up of early years places across xxxxx. Please tick the code which best describes your childs
ethnicity.
Code
WBRI
WIRI
WIRT
WROM
WOTH
MWBC
MWBA
MWAS
MOTH
AIND
APKN
ABAN
AOTH
BCRB
BAFR
BOTH
CHNE
OOTH
REFU
NOBT
Description
White, British
White, Irish
Traveller of Irish Heritage
Gypsy / Roma
White, any other White Background
Mixed, White and Black Caribbean
Mixed, White and Black African
Mixed White and Asian
Mixed, any other mixed background
Asian or Asian British, Indian
Asian or Asian British, Pakistani
Asian or Asian British, Bangladeshi
Asian or Asian British, Any other Asian Background
Black or Black British, Caribbean
Black or Black British, African
Black or Black British, Any other Black background
Chinese
Any other ethnic background
Did not wish to be recorded
Not Obtained
Funding Requests for Early Education for Twos and Early Years Pupil Premium - To be eligible for funding your family
must be in receipt of one of the following:
Income Support
Income-based Job Seekers allowance
Universal Credit
Income-related Employment and Support Allowance
Support under Part VI of the Immigration and Asylum Act 1999
The Guaranteed element of State Pension Credit
Child tax Credit (provided you are not also entitlement to Working Tax Credit and have an annual gross income of no
more than 16,190)
The child has been in local-authority care for 1 day or more in England or Wales (Evidence Required)
The child has been adopted from care in England or Wales (Evidence Required)
The child has left care through a special guardianship or a child arrangement order in England or Wales (Evidence
Required)
The child is entitled to for Disability Living Allowance (Two Year Olds Only Evidence Required)
Parental Agreement please delete as appropriate

I have received the Early Educational Entitlement Free Places for 2, 3 and 4 year Olds A detailed guide for
Parents and Guardians
I agree to the Local Authority using the information provided to enable my childs setting to claim Early Education
Entitlement for my two, three or four year old and / or the Early Years Pupil Premium.
The information I have given on this form is complete and accurate. I understand that my personal information is held
securely and will only be used for the administration of early years funding.
Parent / Carer signature:...Date:
Permissions (please answer all statements)

CCTV I DO / DO NOT ( Please delete) give permission for my child
To be recorded on the CCTV cameras in the building for the purposes as described in the CCTV Policy of
which I have a copy of. (Not applicable at Nutkins, Bretons or Playdays 3)
Food I DO / DO NOT give permission for my child to eat food at Preschool which has been donated or
provided by the preschool or parents. This may include homemade cakes, bread or other produce. I
understand that any food preferences or allergies will be actioned by the staff prior to my child being
offered the food. I confirm that any food or snack items which I bring into Preschool for the children to
consume will be in line with Food Hygiene requirements, eg only Pre-Bagged / Pre-Washed Fruit and
Vegetables, or items that are in packaging (not loose fruit or vegetables).
Learning Journey I DO / DO NOT give permission for my childs key person to take home their learning
journey to update as required. I understand that the paperwork will be taken straight home and that
confidentiality will be upheld at all times.
Photographs During your childs time at preschool we would like to take photographs as evidence of our
work to show Ofsted. These photos will be for use within the setting and for our records only they will
not be used externally. I DO / DO NOT give consent for photographs to be taken by pre-school staff.
Outside Agencies I DO / DO NOT give consent for staff and other agencies such as Ofsted, Area
Senco, Health Visitor to carry out and record observations on my child for the purposes of developmental
assessment.
Outings I DO / DO NOT give consent for my child to be taken out of the setting as part of our daily
activities. I understand that additional consent will be requested for major outings.
Video I DO / DO NOT give consent for the nursery/parent audience (please delete as appropriate) to
record public show events such as Christmas/Easter/Sports Day etc on video.
Facebook I DO / DO NOT give permission for my childs photo (without name) to be used on the
settings Facebook page, website, newsletter and/or local newspaper (please delete as required).
Sunscreen I DO / DO NOT give consent for sunscreen to be applied to my child when necessary.
Changing Clothes It may be necessary to change your childs clothing as a result of messy play,
wet/soiled clothing etc. I DO / DO NOT give permission for the preschool to change my childs clothing
as required.
Nappies I DO / DO NOT give permission for the setting to change my childs nappy as and when
required.
Transitions To support smooth transitions between ourselves and your childs next setting or a setting
they currently attend, it is important to share relevant information such as observations, photos, reports
and data. I DO / DO NOT give permission for this information to be passed on.
Childs Name ..Parents Signature Date.

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Registration Form

Any other information including Dietary, Medical

First Name: _________________________

Gender: Male / Female (delete as appropriate)

Days / Hours Attending

Days / Hours Attending

New Child Registration Form

Start Date at setting

The child below may

EEE Two Year Old Funding

EEE Three Year Old

Early Years Pupil Premium

Gender (please tick)

Home Address and postcode

First /Home Language Spoken

Parent / carer details

Home Address and postcode (if different from above)

Council Tax bill / Gas Bill / Electricity Bill / Water Bill

Parental Agreement please delete as appropriate

Parent / Carer signature:...Date:

Permissions (please answer all statements)

Childs Name ..Parents Signature Date.

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