Registration Form

Nursery Registration Form

Step 1 of 10 - Introduction Information

What is your preferred nursery?*
- Susan Lawrence Nursery
- Shrewsbury Nursery
Have you hada previous discussion with a member of staff from the nursery?*
- Yes
- No
What was the name of the member of staff?
How many days of provision are you looking for?*
Please be aware we need a minimum of 2 days provision to be able to accept your registration
What are your preferred days and hours?*
Monday - Friday, All day (8am-6pm), Mornings (8am - 1pm) or Afternoons (1pm - 6pm)
Are you looking for term time or full time provision?*
- Term Time
- Full Time

Terms and Conditions*
Early Start Nurseries, Shrewsbury and Susan Lawrence, are open 51 weeks of the year, with the exception of public and bank holidays; and a minimum of two days per year for Inset training. For details of admissions, charging and invoicing, please see the Early Start: Admissions, Charging & Invoicing Policy.

Early Start use Tapestry to record your child’s development and to share daily feedback. We host parent/carer consultations/discussion once a term. If you would like more detailed feedback at any time, please contact us and book an appointment; as staff are not available at drop-off, or pick up, to offer detailed feedback in person, as they are dealing with handover of all the children in the nursery.
Early Start promote positive relationships with all our parents/carers and staff. Our staff are here to provide for the care and development of your child, please treat them with respect. Early Start have zero tolerance for what our staff may consider aggressive or abusive behaviour, including shouting, which will not be tolerated. And the fact that it will affect all the children in the nursery. Anyone who behaves in such a manner will be asked to leave the premises. If you wish to raise an issue please speak with the nursery manager, a member of the senior management team, or complete a comment form on the website. Please see the Early Start Feedback: Compliment, Comment, Complaints and/or Concern policy on our website

I. The Nursery will close, including in term-time, for a minimum of two inset days per year, for staff training. Dates will be provided where practicable, four weeks in advance

II. A non-refundable admin fee of £50 must be paid to hold a place: please see the Early Start: Admissions, Charging & Invoicing Policy Once all paperwork has been completed, a tentative offer of a place will be made until the refundable deposit has been paid. The refundable deposit will be based on the nursery service required. Booking will be completed on receipt of the deposit.
Refundable deposit: this will be held on account by Early Start Education (ESE) Ltd for the whole of the period that your child attends nursery. Normally it will be refunded or deducted from your final bill. However, it may be used to cover any outstanding fees at any point. please see the Early Start: Admissions, Charging & Invoicing Policy

III. Nursery fees are calculated on a weekly basis, multiplied by 51 weeks and then divided into twelve equal amounts: this applies even if your child only attends in term time. Please see the Early Start: Admissions, Charging & Invoicing Policy
EE15 hours & EE30 Early Education (EE) funding for two and three+
a. A refundable deposit of £30 must be paid to hold a place. Once all paperwork has been completed, a tentative offer of a place will be made.
b. Your child is registered to receive an EE funded place only. If you wish to extend your hours, you will need to pay for additional hours. Please make a request for additional hours and please see the Early Start: Admissions, Charging & Invoicing Policy for details

Two year old free EE 15 hours x 38 Weeks (term time) = 570 hours for eligible families only)
Three + year old universal offer 15 hours x 38 Weeks (term time) = 570 hours A termly charge will be payable every term for lunch/afternoon tea and a contribution towards consumable materials.
Please see the Early Start: Admissions, Charging & Invoicing Policy
Three + year old EE30 hours x 38 Weeks (term time) = 1140 (Extended offer for eligible families only). For 51 weeks EE 30 hours are stretched to equal EE 22 hours of funding per week = 1140, with fees payable for the remaining hours
Please see the Early Start: Admissions, Charging & Invoicing Policy
c. If your child is not in nursery due to absence, or due to attend nursery on a day that is a bank or public holiday, or an Inset day, no alternative hours will be offered.

IV. Fees are due on the first day of each month by standing order. You MUST inform us in advance if fees are paid by a process that may mean they will not be in our bank account on the first of the month: ie childcare vouchers; national savings etc

V. Children may be excluded from nursery if fees remain outstanding beyond five days and registration may be terminated

VI. ESE reserve the right to serve a statutory demand; pass unpaid fees to enforcement for collection and/or charge interest on overdue fees

VII. Fees, Early Start: Admissions, Charging & Invoicing Policy, and Terms and Conditions are subject to revision, to enable the safe and effective running of the nursery. There will be an annual increase in childcare fees

VIII. One months’ notice is required to withdraw your child from nursery or to change or cancel any sessions. Please see the Early Start: Admissions, Charging & Invoicing Policy
Fees are still payable even if you withdraw your child early from nursery. Make sure to provide a month’s notice

IX. No reduction to fees due to absence, examples include:
Sickness; holidays; public and bank holidays; inset training days or if the nursery has to close due to circumstances beyond our control eg if the water supply to the street, and therefore the nursery, has been shut off with less than 48 hours’ notice etc

X. Early Start reserve the right to charge parents an additional fee for dropping off their children earlier or collecting them later than their booked session time. If your child is not collected by end of session (morning 1pm and afternoon/full day 6pm) you will be billed at a rate of £10 per 15 minutes, and part thereof, and for every 15 minutes or part thereof Please see the Early Start: Admissions, Charging & Invoicing Policy

XI. If your child is suffering from an infectious illness, sickness and/or vomiting and diarrhoea, and/or has been prescribed antibiotics by a medical practitioner, your child may not attend nursery for 48 hours. You must inform staff when dropping off your child, if your child suffered an injury outside of nursery. If we notice an injury that has not been reported to staff, we will contact you to discuss.

XII. The Nursery reserves the right to refuse admission to any child who appears too unwell to attend

XIII. Please provide at minimum one complete change of clothing (including footwear) and label your child’s clothing. We do provide a lost property box, but accept no responsibility for any items that go amiss. The children will take part in lots of messy play, so please dress your child to get messy.

XIV. Please do not send a special toy to nursery with your child. Early Start accept no responsibility for any items that go missing/are broken

XV. Early Start has a duty of care to all children and an obligation to report to governing bodies any incident, in which we consider a child has been abused and/or neglected. This may be done confidentially without informing the parent

XVI. Parents/carers are responsible for registering their children on arrival / departure. You must inform us who will be collecting your child. If this changes throughout the day you must contact us to tell us who will be collecting your child/emergency contacts. We must hold on file information (including photo ID) of this person and you must provide us with their unique password. Failure to provide this information may result in us not allowing your child to leave the setting with an unregistered adult

XVII. Parents/carers are responsible for informing us in writing of any changes to their child’s essential information, including addresses, telephone numbers and any medical conditions or allergies

XVIII. Before your child starts attending nursery we will need to see evidence of which people have parental responsibility (PR) for your child or legal contact with them (full birth certificate, court orders). If circumstances change, including a person with PR being prevented from contact with the child, it is the parents responsibility to update the nursery, including providing proof of non-molestation order/court order

XIX. To attend in time for breakfast your child needs to be in by 8.50am, otherwise you will need to feed them before they come in to nursery

By checking the box on the registration form, you are agreeing and acknowledging that you accept these terms and conditions. If you do not accept and agree to the terms and conditions, your registration will not be completed.
- I agree to the Terms and Conditions
A copy of our terms and conditions and admissions, charging and invoicing policy can be found here
Date of Signature*
DD slash MM slash YYYY
Childs Name*
First Last

Exclusion Procedure For Illness/ Communicable Disease*
Disease\Illness and Minimum Exclusion Period
Antibiotics prescribed - 48 hours exclusion
Vomiting - If sent home ill, child must be off for 48 hours (from last vomiting spell)
Conjunctivitis - If eyes are weepy they must stay at home. May come in with treatment/without treatment if eyes are not weepy, parent needs to come in to administer eye drops as ESE will not administer
Diarrhoea - 48 hours (from last diarrhoea)
Chickenpox - Keep child off nursery until they are no longer infectious, which is until the last blister has burst and crusted over. This usually happens five or six days after the rash begins
Gastro-enteritis, food poisoning, salmonellosis and dysentery - Until authorised by District Community Physician
Hand, foot and mouth disease - Until blisters have disappeared
Infective hepatitis - 7 days from onset of jaundice
Measles - 7 days from appearance of rash
Meningococcal infection - Until recovered from illness
Mumps - Until the swelling has subsided and in no case less than 7 days from onset of illness
Pertussis (whooping cough) - 21 days from the onset of paroxysmal cough
Poliomyelitis - Until declared free from infection by District Community Physician
Scarlet fever and streptococcal infection of the throat - Until appropriate medical treatment has been given and in no case for less than 3 days from the start of the treatment
Tuberculosis - Until declared free from infection by District Community Physician
Typhoid fever - Until declared free from infection by District Community Physician
Impetigo - Until the skin is healed
Pediculosis (lice) - Until appropriate treatment has been given
Plantar warts - No exclusion if treated and covered
Ringworm of scalp - Until cured
Ringworm of body - Seldom necessary to exclude, provided treatment is being given
Scabies - Need not be excluded once appropriate treatment has been given
Oral Thrush - Until appropriate treatment has been given

Children who are ill
It is at the manager’s discretion whether or not to allow a child into nursery if they are showing signs of illness, even if there is no exclusion period, if this is after any exclusion period has passed or if a doctor has stated that they are not infectious. The Manager will need to take into account the demeanour of the child and whether they are well enough to participate in nursery activities. They must also consider whether allowing a sick child in nursery would affect the staff to child ratios, as children who are unwell may require continual one to one attention. If we allow a child showing signs of illness or who has recently recovered from an illness into nursery then we will monitor them regularly and will contact parent/s to ask that they are collected if they become unwell again.
Injury on Arrival
If we notice your child has an injury on arrival, or soon after as may only be visible during personal care, we will ask you to complete and sign a form evidencing how the injury happened and what action was taken. If the staff have any suspicions of abuse and/or neglect it will be reported to the Designated Safeguarding Officer who will then follow the guidelines laid out by London Safeguarding Children’s Board, which includes reporting concerns to local Children’s Services Departments.

Please check the box below to acknowledge you accept the Exclusion Procedure For Illness/ Communicable Disease
Date of Signature*
DD slash MM slash YYYY
Name of Child*
First Last

Name of Child*
First Last
Preferred Name of Child*

Date of Birth*
DD slash MM slash YYYY

Gender*

Male

Female
Address*
Address Post Code

Hair Colour*

Eye Colour*

Religion*
Ethnic Origin*

Nationality*

Language(s) Spoken at Home*

Special Measures
What measures would you like the nursery to put in place to assist your child’s language development if they have English as an additional language – eg; you will provide a list of key words to be used as well as English?
Additional Needs
Details of any disabilities/special needs/ medical condition (please ensure you list any and all conditions and complete a medical protocol/medication form

Parent/Carer One*
Please supply photo identification (valid passport / driving licence) at first meeting
Title First Last
Is address the same as the childs address?*

Yes

No
If Address different please add Home Address
Address Post Code

Password*

Home Telephone Number*

Mobile Number*

Email Address*

Do you wish to add a work address?

Yes
Work Address
Address Post Code

Do you wish to add a work contact number?

Yes
Work Telephone Number

Do you wish to add a work email?

Yes
Work Email

Parental Responsibility*

Yes

No
Payment of Fees*

Yes

No
Collect Child From Nursery*

Yes

No
Contact in an Emergency*

Yes

No
Would you like to add another parent/carer?*

Yes

No
Parent\Carer Two
Please supply photo identification (valid passport / driving licence) at first meeting.
If not applicable please enter NA in the relevant boxes
Title First Last
Is the address the same as the childs address?

Yes

No
If no please add Home Address
Address Post Code

Home Telephone Number

Mobile Number

Email Address

Do you wish to add a work addess?

Yes
Work Address
Address Post Code

Do you wish to add a work contact number?

Yes
Work Telephone Number

Do you wish to add a work email?

Yes
Work Email Address

Parental Responsibility

Yes

No
Payment of Fees

Yes

No
Collect Child From Nursery

Yes

No
Contact in Emergency

Yes

No

Would you like to add an additional emergency contact?*

Yes

No
Name
Please supply photo identification (valid passport / driving licence)in first meeting
If not applicable put NA in the relevant boxes
Title First Last
Relationship to Child
if not applicable put NA in the relevant boxes

Password
if not applicable put NA in the relevant boxes

Address
Address Post Code

Home Telephone Number

Mobile Number

Collect Child From Nursery

Yes

No
Contact in Emergency

Yes

No
Please give us details of any other people who look after your children or settings that they attend, this includes other family members/ registered childminders/ other nurseries or play groups
Please supply photo identification (passport / driving licence) in first meeting

Does your child have any allergies?*
(conditions caused by hypersensitivity of the immune system to typically harmless substances in the environment. These diseases include hay fever, food allergies, atopic dermatitis, allergic asthma, and anaphylaxis.

Please note: Anti histamines/medication will only be administered based on the instructions of a qualified medical practitioner eg GP

A food intolerance is difficulty digesting certain foods and having an unpleasant physical reaction to them. The difference between a food allergy and sensitivity is the body's response. When you have a food allergy, your immune system causes the reaction. If you have a food sensitivity or intolerance, the reaction is triggered by the digestive system.

Yes

No
If yes, please give details of the cause and reaction. You must complete an allergy protocol and have it signed/confirmed by a medical practitioner before your child attends nursery.
Does your child have any medical concerns, additional needs and/or a disability?*
Including asthma, eczema, previous operations, glue ear etc)

Yes

No
If yes please give details
Does your child have any special dietary requirements?*
Dietary requirements: while we will provide food that meets allergy, religious and cultural requirements, we may not provide food that meet lifestyle choices. There may be an extra charge for foodstuffs that are purely for lifestyle choices and they need to meet certain requirements

Please note: You should provide us with details of any religious requirements as well as intolerances, food allergens etc

Yes

No
If yes, please give details
Immunisations*
Immunisations: if you child has not received their immunisations when they attend nursery we have a requirement to inform others that there is a child at the setting not immunised, due to the increased risk. We will not provide any personal details.

Has your child had all of the relevant immunisations? (please look in your child's red health book for reference)
Select All
BCG
Flu
DTaP/IPV/Hib
PCV
Men C
Rotavirus
Hib/Men C
MMR (1st dose)
DTaP/IPV or dTaP/IPV
MMR Booster
BCG
BCG
Birth
Date of Immunisation
DD slash MM slash YYYY

Flu
2 - 7 Years
Date of Immunisation
DD slash MM slash YYYY

DTaP/IPV/Hib
8 Weeks
12 Weeks
16 Weeks
Date of Immunisation - 8 Weeks
DD slash MM slash YYYY

Date of Immunisation - 12 Weeks
DD slash MM slash YYYY

Date of Immunisation - 16 Weeks
DD slash MM slash YYYY

PCV
8 Weeks
16 Weeks
1 Year or 13 Months
2 - 7 Years
3 Years 4 Months
Date of Immunisationv- 8 Weeks
DD slash MM slash YYYY

Date of Immunisation - 16 Weeks
DD slash MM slash YYYY

Date of Immunisation - 1 Year or 13 Months
DD slash MM slash YYYY

Date of Immunisation - 2 - 7 Years
DD slash MM slash YYYY

Date of Immunisation - 3 Years 4 Months
DD slash MM slash YYYY

Men C
12 Weeks
16 Weeks
Date of Immunisation - 12 Weeks
DD slash MM slash YYYY

Date of Immunisation
DD slash MM slash YYYY

Rotavirus
8 Weeks
12 Weeks
Date of Immunisation - 8 Weeks
DD slash MM slash YYYY

Date of Immunisation - 12 Weeks
DD slash MM slash YYYY

Hib/Men C
1 Year or 13 Months
Date of Immunisation
DD slash MM slash YYYY

MMR (1st Dose)
1 Year or 13 Months
Date of Immunisation
DD slash MM slash YYYY

DTaP/IPV or dTaP/IPV
3 Year 4 Months
Date of Immunisation
DD slash MM slash YYYY

MMR Booster
3 Year 4 Months
Date of Immunisation
DD slash MM slash YYYY

Doctors Details
Children should be registered with a GP from birth or first entry into the borough or country.

Name of GP

Name of Surgery

GP Postcode

Dentist Details
Children should be registered with a dentist from nine months or when your first tooth comes out, or whichever is soonest .

Name

Postcode of Dentist

Other agency details eg Social Care; Child Development Centre
Name

Address
Address Post Code

Any other details that we should know about?

I agree for the person in charge to take the necessary steps to ensure that my child receives the best and most appropriate care, attention and treatment should there be an emergency or accident on site or while my child is on an outing. I understand that they will make every effort to inform me as soon as possible, but I give my permission for them to authorise medical staff, at a hospital or dentist, if in their professional opinion it may delay treatment*

Yes

No
I agree for the staff to administer my child 5ml paracetamol, i.e. Calpol if it is deemed necessary by a senior member of staff. The staff will try to inform me by telephone that they are about to administer the medication, but I recognise that this may not always be possible. The staff will record the medication administered and I will see and sign the documentation.*

Yes

No
I agree for staff to administer prescribed medication/ teething gel supplied by me, such as inhalers, epipens or insulin in line with the instructions from a medical practitioner, ie doctor or dentist, and having undertaken specialised training if deemed necessary. The staff will record the medication administered and I will see and sign the documentation. I must complete a medication form with all the details*

Yes

No
I agree for staff to apply sun cream as required*

Yes

No
I agree for my child to take part in the daily Supervised Tooth Brushing Programme*

Yes

No
I give my permission for my child to have contact with any animals that visit the nursery, knowing that the staff will ensure that appropriate health and safety procedures are followed*

Yes

No
I agree for my child to be photographed or filmed on certain occasions, for example at the Christmas Play, Outings, Evidence of Learning*

Yes

No
I give permission for nursery staff and childcare students to observe my child and record these observations in their learning journey (papers recording and through a secure online system), with photographs/footage for Evidence of Learning*

Yes

No
I understand that some members of staff will be working toward an NVQ Award in Early Years and Education and as part of this may use written observations about my child. I consent to these observations being used in their portfolios and understand that any reference to my child will be anonymised*

Yes

No
I agree to my child being taken out on pre-arranged local outings for Evidence of Learning*

Yes

No
I am happy for staff to share information about my child’s learning and development with staff at other settings that they attend and other people who look after them on a regular basis*

Yes

No
I understand that my child will be included in other children's Evidence of Learning in text, pictures and videos via the Online Learning Journal (Tapestry) and that this information is shared with other parents/carers within the nursery setting*

Yes

No
Additional funding may be available through EYPP, paid to providers for the provision of extra support for children of families in receipt of certain benefits. Children who are looked after or have left care of the local authority through adoption or special guardianship are also eligible. EYPP is for children aged three or four and is used to improve teaching and learning facilities and resources to impact positively on your child’s progress.*
Do you wish your provider to apply for EYPP? This check will use the information supplied by you on this form or you may need to provide evidence such as a copy of an adoption certificate or a copy of the special guardianship/residence order.

Yes

No
Any further details you would like to add
Signature*
Date of Signature*
DD slash MM slash YYYY

Name of Parent/Carer*
First Last
Consent/GDPR*
I agree that Early Start Education can hold my hold information and that I have read the Privacy Notice. Your information will never be shared with 3rd party providers.
A link to our privacy notice can be found here: Privacy Notice