Registration for Nursery Surname First Name (s) Date of Birth Known Name Gender Male/Female Parent/Guardian 1 Parent/Guardian 2 Other Full name Full name I give permission for the following person to be contacted to collect my child from nursery or school in an emergency. Address Address Name and address Post Code Post Code Phone Home Phone Home Telephone Number – – Mobile Mobile Work phone, location Work phone, location Relationship to child E-mail E-mail Previous Setting Yes/No Yes/No Parental responsibility Parental responsibility Mother / Father Mother / Father Religion Mother Tongue Ethnicity Medical details MU Muslim BE Bengali Asian or Asian British Name and – – Doctor’s Indian Surgery Address CH Christian EN English Pakistani – – Bangladeshi HD Hindu GU Gujarati – – Chinese Any other Asian background SI Sikh HI Hindi – – Black or Black British JW Jewish PA Panjabi Caribbean – – African BU Buddhist UR Urdu – – Any other Black background Telephone Mixed/Dual background NR No Religion PU Pushto – – White and Black Caribbean OTHER please state OTHER Please state White and Black African – – White and Asian Asian and Black Permission to contact Other mixed background doctor in an emergency White Yes / No British Irish Traveller of Irish Heritage Gypsy/Roma Permission to administer Any other white background first aid in an emergency Other Yes / No Any other ethnic group I do not wish a category to be recorded Medical Conditions / Allergies
Registration for Nursery Surname First Name (s) Date of Birth Known Name Gender Male/Female Parent/Guardian 1 Full name Parent/Guardian 2 Full name Other I give permission for the following person to be contacted to collect my child from nursery or school in an emergency. Name and address Address Address Post Code Post Code Phone – Home Mobile Phone – Home Mobile Telephone Number Work phone, location Work phone, location Relationship to child E-mail E-mail Previous Setting Parental responsibility Yes/No Mother / Father Parental responsibility Yes/No Mother / Father Religion MU – Muslim CH – Christian HD – Hindu SI – Sikh JW – Jewish BU – Buddhist NR – No Religion OTHER – please state Mother Tongue BE – Bengali EN – English GU – Gujarati HI – Hindi PA – Panjabi UR – Urdu PU – Pushto OTHER – Please state Ethnicity Asian or Asian British Indian Pakistani Bangladeshi Chinese Any other Asian background Black or Black British Caribbean African Any other Black background Mixed/Dual background White and Black Caribbean White and Black African White and Asian Asian and Black Other mixed background White British Irish Traveller of Irish Heritage Gypsy/Roma Any other white background Other Any other ethnic group I do not wish a category to be recorded Medical details Doctor’s Name and Surgery Address Telephone Permission to contact doctor in an emergency Yes / No Permission to administer first aid in an emergency Yes / No Medical Conditions / Allergies
Field%20Lane%20Nursery%20Registration%20Form-58122.docx