Registration Form

Child's Surname

Child's Forenames

Date of Birth

Day

Month

Year

Position in family (e.g. 2nd of 2)

Multi-line address

Country/Region

Address

City

Zip / Postal code

Parent's Names

Email

Phone

Mother/Father's Address if different to above

Languages spoken at home

Does your child have any special educational need or disability (SEND) (e.g. medical/physical/behavioural condition such as sight impairment, delayed speech or allergy)?

Yes

No

If Yes to the above, please provide further details

Is your child receiving SEND support from any of the following

Please tick any that apply

Does your child have or is in the process of applying for any of the following

An Education, Health and Care Plan (EHCP)

High Needs Funding (HNF)

Common Assessment Framework (CAF)

Early Support Plan (ES)

Individual Assessment of Early Learning and Development (IAELD)

None of the above

Please tick any that apply

I consent to share any documentation or reports relating to my child’s special educational need or disability and give St Michael's Pre-school permission to contact professionals involved with my child so that they can best meet my child’s individual needs.

Please indicate here ideally when you would like your child to start with us – we typically have one September intake each year and will occasionally offer spaces in January, dependent on numbers

Does your child currently or plan to attend another childcare setting?

If Yes, please provide details below

I consent to St Michael's Pre-school contacting my child's other setting to obtain learning and development information to provide for smooth transitions.

Signature

Signature field is empty.

I/We agree to make payment of the £30 administration fee and understand that my child will not be added to the waiting list until this has been received. The administration fee covers the cost of settle sessions, a book bag and associated administrative costs. Please note this is refundable if we cannot offer your child a place.