Registration Form - fishandbricks.co.uk

Child's Full Name *

First

Middle

Last

Date of birth

Address

Email *

Telephone Contact:

Full Name of Legally Responsible Parents / Guardians: *

Siblings

Emergency Contact Name and Number

Doctor's Name

Health Visitor

Does your child have any special needs?

Home language

Any known allergies?

Has your child had all vaccinations currently in G.P's programes?

In an emergency my child will receive necessary medical treatment. As part of our integrated working, information will be shared with other relevant professionals eg. schools, speech therapists, shared settings, etc.

My child can take part in well-supervised excursions

Single Line Text

Signed *

The Manager will need to see your child's Birth Certificate. Please submit this form and we will contact you to make your voluntary contribution (the suggested amount is £15) towards resources and equipment.

In accordance with the General Data Protection Regulation, GDPR, the information you submit will be held under the Fish & Bricks Data Protection Policy securely. We will only use this service to deliver pre-school services to your child.

I accept