The Roundabout Day Nursery

1 The Roundabout Day Nursery Rear of 131 Main Road Kesgrave, Suffolk IP5 1AA Tel:(01473) 333733 Please complete this admission form and return it to the Nursery . It is important that changes in this information are notified promptly to maintain accurate records. ABOUT YOUR CHILD Child s Address .. Home telephone no .. Mobile no .. Email address:.. Child s date of PARENTS DETAILS Parent/guardian s name .. Parental responsibility This information is only shared with the strictest confidence to team members who must be aware of such details.

2 Who has parental responsibility for your child? .. Where a child s mother and father were not married to each other at the time of his/her birth the mother has parental responsibility but not the father. He can obtain PR under the Children Act by a court order, formal agreement with the mother, his appointment as a guardian, or by marriage to the mother. Parents who were married to each other at the time the child was born both have parental responsibility and continue to have PR even if they are subsequently divorced. (As defined in the Children Act 1989). OTHER PERSON TO BE CONTACTED IF THE PARENT IS UNAVAILABLE OR IN AN EMERGENCY. (This information is ESSENTIAL should anything happen to YOU or the child). Name .. Daytime .. Daytime telephone no ..mobile .. Relationship to child.

3 COLLECTION OF YOUR CHILD Name of person who will usually collect your child .. Relationship to child .. Contact telephone no ..mobile .. Parents must inform the Nursery manager in advance if a different person will be collecting their child. We operate a password system which the person collecting your child must know. Any unauthorized person trying to collect a child will not be allowed to leave with the child and the parent of the child will be contacted immediately and asked to make appropriate arrangements. Password .. DOCTORS INFORMATION GP s Name .. Surgery Address ..Tel no .. HEALTH VISITOR Name .. Address ..Tel no .. IMMUNISATIONS/VACCINATIONS Has your child been fully immunized against : Diphtheria dates .. Polio dates.

4 Tetanus dates .. MMR dates .. Whooping Cough dates .. HIB Meningitis dates .. Meningitis C dates .. Other (please detail).. INDIVIDUAL NEEDS Please indicate if your child has any special needs, allergies (including food and drink) or special dietary needs on medical, religious, cultural or other grounds.. Child s first language .. Other language(s) spoken at home .. Has your child any additional medical problems or phobias? .. We would welcome any additional information that you feel is necessary special comforters, toilet training needs etc.. PERIOD OF CARE REQUIRED Please tick sessions required Monday Tuesday Wednesday Thursday Friday Breakfast Morning Lunch Afternoon Tea Starting date.

5 Parent s responsibility to notify the Nursery of any changes to these details immediately. I .. agree to pay Nursery Fees monthly in advance (parent/guardian) Child Protection I have received and agree to the Nursery Child Protection Policy. Name of Child .. Signature of parent or guardian .. Date .. Payment of Fees I have received and agree to the Nursery Admission Policy. Name of Child .. Signature of parent or guardian ..Date .. Behaviour Policy I have received and agree to the Nursery Behaviour Policy. Name of Child .. Signature of parent or guardian .. Date .. Collection Policy I have received and agree to the Nursery Collection Policy. Name of Child .. Signature of parent or guardian .. Data Protection I agree that the Nursery may hold this information. I agree to advise the Nursery of any changes to these details.

6 I understand that this information will be available to Nursery staff and that I may inspect this information relating to my child. Signature of Parent or guardian ..Date .. Consent Forms Medical Emergency Every effort will be made to contact parents/guardians if any emergency occurs, but should an emergency occur, I give my permission for the staff to take appropriate action. If necessary my child may be taken to hospital. I consent to any medical treatment as is deemed necessary. Name of child .. Signature of parent or guardian .. Date .. Walks, Visits, Outings etc. I give permission for my child to participate in supervised walks, visits or outings etc. The Nursery staff as appropriate will give prior notice.

7 Name of child .. Signature of parent or guardian ..Date .. Observations and Photographs I give permission for my child to be photographed, supervised by a Nursery staff member. I understand I will be informed if my child s photograph will be seen publicly ( newspapers, publication). Name of child .. Signature of parent or guardian ..Date .. Sun cream I agree that the Nursery staff can apply sun cream to my child. I also agree to supply sun cream for my child. Name of Child .. Signature of parent or guardian .. Date .. Plasters I agree that the Nursery designated First Aider can apply plasters when deemed necessary. Name of Child .. Signature of parent or guardian ..Date .. PARENT/CARERS CONTRACT We have made a commitment to provide a quality childcare service and keep you involved and informed and would like you to agree to the following: I understand that: Nursery fees should be paid one month in advance.

8 Nursery fees should be paid by no later than 15th of each month. If not a late fee charge of will be incurred. Payment is made either by debit/credit card, cash or on-line banking. There is a charge for using a credit card. If my child is unable to attend I will let you know as soon as possible I will keep you informed of any change of address/ emergency contact details If my child is absent for any reason that the fees are still due. I am ultimately responsible for the behaviour of my child and will accept responsibility for any damage caused by him/her I will collect my child by 6pm. If I am likely to be late I will let you know. I accept that a fee will be charged at a rate of per 15 minutes over my contracted hours. Medication will only be administered if written instructions are supplied by their parent/carer I agree to give 4 weeks notice for holidays in writing.

9 If not full fees will be due. I agree that my child has been allocated 12 days holiday per year at no charge. Any additional time taken will be charged at 50% of my usual fees. This does not apply to children who attend on a school term time contract. I agree to give 1 months notice of changes to sessions in writing. I agree to give 1 months notice to terminate my contract with the Nursery and cancel my child s place. I agree to pay any fees due when notice has/has not been given. I agree to the terms and conditions as detailed above. Please sign both copies and keep one for your records. Name of