Registration Form

About Your Child

If you have more than one child that you would like to attend the nursery, please complete a separate form for each child. Thank you.

Child's First Name(*)

Please let us know your child's first name.

Child's Middle Name

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Child's Last Name(*)

Please let us know your child's last name.

Child's preferred name

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Child's Gender(*)

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Child's DOB(*)

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Child's Religion(*)

Please let us know your child's Religion.

Ethnic Origin(*)

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Important Information

Primary Language(*)

Please let us know your child's Primary Language

Secondary Language

Please let us know your child's Secondary Language

Medical Information

GP's contact Details

GP Name(*)

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Surgery Name(*)

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Address line 1(*)

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Address line 2

Address line 3

City/Town(*)

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Postcode(*)

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GP Contact Number(*)

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Email address

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Does your child have any medical conditions?(*)

Yes (please provide details below)

No

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Medical Details

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Allergies(*)

Yes (please provide details below)

No

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Allergy Details

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Dietary Requirements(*)

None

Vegetarian

Vegan

Other (please provide details below)

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Diet Details

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Does your child have any special educational needs?(*)

Yes

No

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Including physical impairments and/or learning difficulties. (There will be an additional area to discuss further funding/support your child receives).

SEN Details

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Is your child receiving support from any other agencies? (*)

Please confirm if child recieves additional financial or learning support

e.g. social services, GP or health visitor? Or any additional financial support?

Please give details of support

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Session Requirements

Click here for more information

Required Start Date(*)

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Contact 1 Details

First Name(*)

Please enter Contact 1's First Name

Last Name(*)

Please provide Contact 1's Last Name

Relationship to Child(*)

Please provide relationship to child

Occupation(*)

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Mobile Phone Number(*)

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Work Phone Number(*)

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Home Phone Number

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Email address(*)

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Please confirm email address(*)

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Secret Word / Password(*)

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You can provide a family password to be given by another person (other than the primary/secondary contact) when picking up your child.

Contact 1 Address

Address line 1(*)

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Address line 2

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Address line 3

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City/Town(*)

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Postcode(*)

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Contact 2 Details

First Name(*)

Please enter Contact 2's First Name

Last Name(*)

Please provide Contact 2's Last Name

Relationship to Child(*)

Please provide relationship to child

Occupation(*)

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Mobile Phone Number(*)

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Work Phone Number(*)

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Home Phone Number

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Email address(*)

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Please confirm email address(*)

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Secret Word / Password(*)

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You can provide a family password to be given by another person (other than the primary/secondary contact) when picking up your child.

Contact 2 Address

Address line 1(*)

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Address line 2

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Address line 3

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City/Town(*)

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Postcode(*)

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Registration

Click Here for more information on Sessions and Fees

I will be claiming government funded entitlement sessions:(*)

No

15 hours

30 hours

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Please indicate where you found out about us

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Declaration(*)

I declare that the information included in this registration form is accurate, and that I will inform Burgh Wood Montessori Nursery School of any changes to the primary and secondary contact names and/or details included in this registration form.

Please confirm you have read and agreed to our T&Cs

Form Completed by:(*)

Contact 1

Contact 2

Please confirm who has completed this form