The Exwick Ark

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Child Information

Child Name

Nursery Start Date

Sessions/Days Required

Date of Birth - Child

Address *

Postal code *

Three/Two Year Old Funding Code (If Applicable)

Parent Information

First Name *

Last Name *

Phone *

Email *

Date of birth *

Do you have parental responsibility (parent 1)

Parent NI Number

Occupation (Indicate if Keyworker)

Parent 2 First Name

Parent 2 Last Name

Parent 2 Email

Parent 2 Phone

Do you have parental responsibility (parent 2)

Parent 2 NI Number

Parent 2 Occupation (Indicate if keyworker)

Permissions

Allow photos and videos for nursery website, social media and Facebook (public page)

Allow photos for child development evidence, Ofsted, display boards & training within nursery

Allow my child to be included in group observation photographs (note - parents are requested not to share group images on social media)

Yes

No

I give permission for staff to seek emergency medical advice or treatment if necessary (in the event of the above I will be contacted immediately)

I give permission for a member of staff to apply barrier cream for nappy rash

Emergency Information

Emergency Contact (Name & Phone) Use a different contact from parents and state relationship to child.

Emergency Contact 2 (Name & Phone) Use a different contact from parents and state relationship to child.

Blue Light Card Number (If Applicable)

Collection Password

Captcha

I confirm that I have read and understood this form and the Terms and Conditions and agree to the contents. I understand that the nursery reserves the right to make amendments to this form and to their terms and conditions from time to time.

Confirmation and Digital Signature

Clear

The Exwick Ark

Website : https://exwickark.co.uk/