Child Enrolment Form

Step 1 of 5 Completed

Childs Details

It is important that you provide accurate and current information about the child you would like to enrol.

Childs Details
Gender
Please specify the language most spoken at home
All Current Immunisations
Step 2 of 5 Completed

Parental Responsibility

Please provide accurate and current information of parents, guardians and/or carers with legal parental responsibility.

Parental Responsibility Delete Add Parent
Step 3 of 5 Completed

Wellbeing and Healthcare

Please provide accurate and current information of parents, guardians and/or carers with legal parental responsibility.

Emergency Contact Delete Add Contact
Child Collection Details
Please provide the name of the person who will usually collect the child
Alternative Child Collection Details Delete Add Collector
Please provide the name of an alternative person who may collect the child
Medical Details
Please provide details of all allergies/dietary requirements/health problems/medication/childhood illnesses
Please provide details of any special educational needs/disabilities
Healthcare Details
Please provide the name of the childs GP and Practice
Please provide the name of the childs health visitor details and clinic
Please provide details of any other professionals involved in your child's care
Step 4 of 5 Completed

Permission and Consent

Please provide accurate and current information of parents, guardians and/or carers with legal parental responsibility.

EyLog - Online Learning Journey
Permissions
I give consent for staff to administer medication as per medication policy Administer Medication
I give consent for staff to administer emergency treatment through First Aid Administer First Aid
I give consent for staff to take child to hospital in emergency with a written consent if there is a delay in getting parents signature Hospital Admitance
I give consent for photographs to be taken, including for use in promotional material Photography Consent
I give consent for the child to go on outings off the premises and/or travel in a company vehicle Excursions and Travel
I give consent for staff to apply sunscreen and/or nappy cream if appropriate Cream Application
I give consent to pass on parents and children's details to the Leicester City Council and any other relevant third parties to apply for additional funding such as the Early Years Pupil Premium Data Consent
I give consent for my child to brush their teeth within the setting Brush Their Teeth

I consent to the details outlined in this form and declare that all the information provided is accurate to the best of my knowledge.

Print Name

Signature

Please draw your signature in the box below and the click the save button.
Signature Instructions

1. Please use your mouse to draw in the signature box in white.

2. You can undo or delete the drawing using the buttons labeled below.

3. Once you are happy with your signature please press SAVE to save the signature before submitting the completed form.