Registration Form for The Shepherd's Hut

Child’s first name: *

Child’s surname: *

D.O.B: *

Preferred name:

Gender: *

Male

Female

Sessions required: *

Start date: *

Address: *

Wendover

Post code: *

Does your child currently attend another setting or has done previously?: E.g. nursery/childminder/pre-school *

Yes

Primary contact first name: *

Surname: *

Relationship: *

Address: *

Wendover

Contact number: *

Work number:

Email address: *

Occupation:

Are there any other contact restrictions?:

Yes

Details:

During day I may be on conference calls/meetings so email at times may be quicker. eva.jacobs@premierfoods.co.uk
or my husband Filipe 07586312039

Secondary contact first name: *

Surname: *

Relationship: *

Address: *

6 Ritson Lane, Aylesbury, HP18 0ZD

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: *

2 Grecian Street
Aylesbury
Bucks 
HP20 1LT

Mobile number: *

Work number:

Contact No.2 name:

Relationship:

Address:

2 Grecian Street
Aylesbury
Bucks 
HP20 1LT

Mobile number:

Work number:

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

Alison Duggan - Granny

Doctor's name: *

Surgery address: *

Poplar Grove Practice
Meadow Way
Aylesbury
HP20 1XB

Surgery phone Number: *

Allergens severity: *

Very high

High

Medium

Low

Allergen's Name:

Medical condition(s) if any:

Does your child have any dietary requirements?: *

Yes

Dietary requirements:

Specific likes/dislikes: *

Loves dinosaurs!

Medication (Please list any medication your child takes regularly and the dosage):

None

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

Yes

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

None

Any other relevant information we may need to be aware of? Put N/A if not applicable: *

Sebastian is correct rly half potty trained.  He is nappy free most days but currently refuses to do poo poo on the toilet (weed on the toilet is fine) so he has a ‘poo poo pull up’.  I doubt very much this will effect his one day in nursery as I feel he’s likely to hold any need to go until he’s in his home environment but I will always send a pull up in his bag of things.  We are working on toilet training and Hopefully We will get it licked soon.

Religion: *

Christian

Muslim

Buddhist

Jewish

Sikh

Hindu

None

Prefer not to say

Others - please state

Other Religion:

Secret password: *

First language:

English

Any other relevant information:

None that I can think of - we’ll work things out as we go along.

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

Any other instructions :

Please send a copy of your child’s birth certificate and immunization records via Cheqdin’s registration messages section in your web portal login or email it to office@shepherdshutdaynursery.co.uk

Declaration :

I accept the terms and conditions of The Shepherd's Hut Outdoor Day Nursery.

Yes No

Full Name of Parent/Carer:

Digital Signature

Sophie

Date & time:

09, Oct 2020 11:01 am

The Shepherd's Hut - Wendover

Child Details

Parental Responsibility

Emergency Contacts

Medical Info

Other Details

Consents

Terms of Service