|
|
| |
|
| Child's Name
.................................................................................. |
Date of
Birth……………...............................
|
| Address
..........................................................................................
....................................................................................................... |
Tel: No:
.....…………..................................... |
| Parent/Carer……………............................................................... |
Postcode
......................................................... |
Contact name/address and telephone
number in case of emergency
........................................................................................................................................................................................................ |
| Days you would like your child to
attend (please circle) |
|
| Mon (am) |
Tue (am) |
Wed (am) |
Thu (am) |
Fri (am) |
9.00am - 11.30am |
| Mon(pm) |
Tue(pm) |
Wed (pm) |
Thu (pm) |
Fri (pm) |
12.30pm-3.00pm
(when numbers require opening
pm sessions) |
| Starting from
...........……………............ |
|
| Intended Infants
school…........................ |
|
| Date of Entry
......................................... |
|
| No child may be received into
Playgroup if he/she appears to be suffering from any infectious disease.
|
| Name of Child's
Doctor........................................................................................ |
Address & Tel: No:
..............................................................................................
|
| Child's Health
Visitor............................................................................................ |
| Has your child been immunised against the
following: - (Please delete as applicable) |
| Diphtheria |
Yes/No |
Polio |
Yes/No |
| Tetanus |
Yes/No |
Whooping Cough |
Yes/No |
| Measles |
Yes/No |
HIB |
Yes/No |
Does your child have any known
allergies? Please specify ..........................................
|
| Should urgent matters of concern
arise, I give permission for my child to be given emergency treatment as
necessary and/or for contact to be made with the appropriate
medical/health/social services. |
| Signed
................................................................
Date..................................... |
Other information, which could help
Playgroup
|
|
| Names of other children in family |
Name............................ |
Age............ |
|
Name............................ |
Age............ |
|
Name............................ |
Age............ |
|
Name............................ |
Age............ |
Any Pets or Friends that your
child is fond
of?
........................................................................................ |
| Any previous attendance at other
playgroups?…………………………………………………. |
Are there any further details
about your child, which could help Playgroup? (For example, spells in hospital,
change of house, family illness, etc)
|
In which ways do you think your
child will benefit from attending our Playgroup?
|
| I give permission for my child to
be taken to Banwell Primary School during Playgroup hours. |
Signed
|
Date |
| I give permission for my child to
have his/her photograph taken. |
Signed
|
Date |
| I have read the Parents Handbook
and Admissions Policy, and I agree to abide to the conditions thereof.
|
Signed
|
Date |
| THE ABOVE INFORMATION WILL BE KEPT
CONFIDENTIAL |
BANWELL PRE-SCHOOL PLAYGROUP
Registered Charity No: 283326
PAYMENT
AGREEMENT FORM |
| Child's Name:
..................................................................... |
| Please Circle |
| Days Attending |
AM Session |
MON |
TUES |
WED |
THUR |
FRI |
| |
PM Session |
MON |
TUES |
WED |
THUR |
FRI |
| Please Circle |
PAY DAILY |
PAY WEEKLY |
PAY HALF TERMLY |
PAY TERMLY |
Fees are payable in advance (£6.50 per
session per child) There will be no charge for Bank Holidays and In Service
days (staff training days). A statement will be issued to parents/carers at the
beginning of each half term indicating the amount due.
Should payments
fall into arrears by two weeks your child will not be able to attend Playgroup.
If a child does not use the Playgroup for a session or sessions for which
he/she has been booked, the fees are still due. In case of illness, fees will
only be waived if a hospital note is provided. If absence due to illness
extends beyond one week inform the staff and an appeal may be made to the
committee.
ANY OUTSTANDING FEES LEFT OWING FROM PREVIOUS SIBLINGS
ATTENDING PLAYGROUP REQUIRES TO BE CLEARED PRIOR TO YOUNGER SIBLINGS
COMMENCING. |
Signed
|
Date |
| FOR OFFICE USE ONLY:- |
Actual Date
Started:..................................
|
Statement:..................................
|
Funded
from:.................................. |
Key worker
allocated:..................................
|
Name mat, coat peg, box:
..................................
|
|
