Online Application Form

Child Information

Preferred Date to Start:  
Given Names:*     Last Name:*     Sex:*  
Is, or was, your child known by any other name? Yes    No    If so, what?  
Date of Birth:*    (Verification to be provided) Culture:*  
Placeof Birth:*     Languages Spoken:*     Religion:*  
Address:*     Postcode:*  
Health/Ambulance Fund   Yes  No  Name


Has your child attended other children's services (playgroup etc) or been cared for outside the home before?
Please tell us how we can help your child this year (e.g. what do you want most for your child at the Centre)?
Is there any practice in relation to your culture or religion that you would like us to observe whilst your child is at the Centre?
Does your child need patting to fall asleep?   Yes  No
Do we have your permission do so as well?   Yes  No