Child Details

Child Name *

Date of Birth - Child *

Gender

Male

Female

Preferred sessions & start date. Please note whether entitlement or fee session: *

Pre-School location (Bromley/ Alderwood CC/ New Eltham/ Bexley Rd/ Eltham High St/Henwick/Horn Park): *

Position in family and number of siblings: *

Address: *

Postal code: *

Birth certificate no. PLEASE forward for ID : *

Do you have another child?

Yes

Second Child date of birth

Second Child Name

Second Child Gender

Male

Female

Second Child Pre-School location (Bromley/ Alderwood CC/ New Eltham/ Bexley Rd/ Eltham High St/Henwick/Horn Park)

Preferred sessions & start date. Please note whether entitlement or fee session (second child):

second Child's Address:

Second Child Postal code

Birth certificate no. PLEASE forward for ID (Second Child):

Parental Responsibity

Primary contact first name: *

Surname: *

Relationship: *

Full address: *

Contact Number: *

Work Number: *

Email: *

Occupation : *

Are there any other contact restrictions? *

Yes

National insurance number & D.O.B. PLEASE forward photo ID. Any other details: *

Secondary contact first name: *

Secondary contact address: *

Relationship: *

Secondary contact surname: *

Contact number: *

Occupation and work number: *

Email: *

National Insurance number and DOB. Please forward photo ID: *

Custody of the child is with. if not ticked we assume primary contact responsibilty : *

Primary Contact

Secondary Contact

Both( Joint Custody)

Other

Emergency Contacts

Any other details:

Emergency Contact (1) name with permission to contact incase of an emergency. *

Relationship: *

Address & contact restrictions (e.g can/ can not collect in an emergency): *

Mobile number: *

Work number: *

Emergency Contact (1) Email

Emergency Contact (2) name with permission to contact in case of an emergency. *

Relationship: *

Emergency Contact Password *

Mobile/home telephone number:

Work number: *

Emergency Contact (2) Email

Significant people residing in childs household:

Other significant information/ adults/ siblings not residing in childs household: *

I, hereby consent and grant permission to the following persons to collect my child (Must be 18 years or over), I also confirm understanding of Crafty Wizards Pre-Schools terms and conditions along with the entitlement declaration. *

Medical Info

Doctor's Name and/ or Practice : *

Surgery address: *

Surgery Phone Number: *

Allergen's name: *

Medications condition(s) if any *

Does your child have any dietary requirements ? *

Yes

Special needs: *

Specific likes and dislikes: *

Medication( please list any medications your child takes regularly and the dosage): *

Does your child have any special eduaction needs(SEN)? *

Yes

If your child has any learning difficulties/disabilities or requires additional assitance , please list them here: *

Health visitor details and other agency details if applicable. Any other relevant information we may need to be aware of? *

Please read our Terms & Conditions

Any other instructions :

Please send a copy of your child's birth certificate, primary carers photo ID, the 'Getting to know your child' form via email and make payment of the resource bundle

Declarations

accept Crafty Wizards Pre-School's Universal Contract Aqreement Part A and B found here on the terms and conditions link. *

Yes

Full name of Parent/Carer: *

Digital signature *

Clear

Date and time