Registration Form for Chatterbox Childcare Ltd

Primary contact first name: *

Surname: *

Relationship:

Address: *

41 Patrickbank Crescent

Contact number: *

Work number:

Email address: *

Occupation:

Are there any other contact restrictions?:

Yes

Details:

Ann Nimmo

Secondary contact first name:

Surname:

Relationship:

Address:

Mersen, 11 woodside Ave, Motherwell

Contact number:

Work number:

Email address:

Occupation:

Custody of the child is with:

Primary contact

Secondary contact

Both (joint custody)

Other

Contact no.1 name:

Relationship:

Address:

41 Patrickbank Crescent

Mobile number:

Work number:

Contact No.2 name:

Relationship:

Address:

92 Main road elderslie.

Mobile number:

Work number:

I, hereby consent and grant permission to the following persons to collect my child (Must be 18 years or over):

Norah Black - 07814278278
Jane Devlin - 07766833715
Eric Black - 07712296875

Allergic reactions - Severity: *

Not Applicable

Very high

High

Medium

Low

Allergies, if any:

Medical conditions, if any:

Instructions for any medication: Should your child require any medication in the course of the day you must complete an Administration of Medicines consent form obtainable from a member of staff and the medicine should be clearly labelled with the Childs name and in the original container.

O

Special needs:

Does your child have any dietary requirements?:

Yes

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

None

Child's Doctor: *

GP Telephone Number: *

GP Practice Address: *

Greeenlaw Medical Centre

Any other relevant information we may need to be aware of ?:

N/A

Does your child have any special educational needs (SEN)?:

Yes

Religion:

Christian

Muslim

Buddhist

Jewish

Sikh

Hindu

None

Prefer not to say

Others - please state

Other Religion:

Please read our Terms & Conditions View T&C's

Any other instructions : Early registration is recommended. Registrations will be considered in the order in which they are received. This form must be signed by the parent(s)/ guardian(s) with parental responsibility; applying for admission of the named child and who it is assumed will be responsible for the fees. For more details, please visit our website: www.insert-your-website-address-here.com. Please send a copy of the child’s passport page to confirm the details. Additionally, include a copy of the child’s most recent school report to support your application. These attachments can be sent to example@school.com quoting the child's name and the registration reference number that you will receive when you submit the application.:

Declaration :

I accept the terms and conditions of [School Name]

Yes No

Full Name of Parent/Carer:

Digital Signature

David

Date & time:

13, Sep 2024 11:16 pm

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