Fields marked with * are required Child's full name * Name known by Address line 1 * Address line 2 Address line 3 Postcode * Start date * 1st language * Nationality * Religion Date of birth UnknownParent 1 Name * Address line 1 * Address line 2 Address line 3 Postcode * Contact number * Employer * Employer's contact number * Parent 2 Name * Address line 1 * Address line 2 Address line 3 Postcode * Contact number * Employer * Employer's contact number * Who does the child normally live with? * Email address * Name of person who holds legal guardianship of child * Name of person who has parental responsibility * Alternative emergency contact name * Alternative emergency contact contact number * Named Person(s) who may collect the child? Person 1 Name Person 1 Relationship Person 2 Name Person 2 Relationship Person 3 Name Person 3 Relationship Password for those who can collect * Health Declaration Doctor's name * Doctor's telephone number * Doctor's address line 1 * Address line 2 Address line 3 Postcode * List of vaccinations received * Illnesses to date Is your child taking any medication?YesNo If yes, what medication? Please give details of any other medical conditions Health visitor's name Health visitor's telephone number Health visitor's address line 1 Address line 2 Address line 3 Postcode Booking formPlease select your requirementsMondayMorning 7.50am – 1pmAfternoon 1pm – 6pmFull Day 7.50am – 6.00pmTuesdayMorning 7.50am – 1pmAfternoon 1pm – 6pmFull Day 7.50am – 6.00pmWednesdayMorning 7.50am – 1pmAfternoon 1pm – 6pmFull Day 7.50am – 6.00pmThursdayMorning 7.50am – 1pmAfternoon 1pm – 6pmFull Day 7.50am – 6.00pmFridayMorning 7.50am – 1pmAfternoon 1pm – 6pmFull Day 7.50am – 6.00pm Additional comments Please tick as applicable * Please note we do not offer term time bookings for children under 2Term time onlyAll yearFunding InformationDo you receive free funding? *YesNoIf yes... What date does your funding start? 15/30 hours code Parent/Carer D.O.B Parent/Carer National Insurance number Please provide Name(s) and Date of Birth(s) of other children in the household: Medication Consent FormI authorise Rosehill Day Nursery to administer any prescribed medicines to my child at the agreed time as stated by the doctor. I understand that no medicine may be administered without the Medication Administration Form being completed in each individual instant.I authorise use of ad-hoc paracetamol products and antihistamine to control any pain or fever my child may have. I understand that if any medicines are administered I will be contacted to advise.Allergies Notification Details My Child has the following allergies * (if none known, please state this below): If a reaction occurs, I am aware that I will be called immediately, and will be expected to collect my child for any necessary treatment.Suncream ConsentI am happy for my child to have sunscreen applied by Rosehill Day Nursery. I give my consent to use sun cream from Rosehill Day Nursery, as they do not have any allergies to this.Dietary Requirements My Child has the following special dietary requirements * (if none, please state this below): TransportI hereby grant any person nominated by the Management of Rosehill Day Nursery permission to collect my child from nursery or take on any outings using transport, whilst in their care. The transport used will be of sound condition, adequately insured and each child will wear a seat belt. I understand that I will receive a separate form indicating what trips are being operated, and any cost involved. I agree to pay for any additional trips (if applicable) in full no later than the day the trip is running. I also understand that the nursery takes full responsibility for all necessary risk assessments to be carried out accordingly.Photographs / VideosI hereby agree that during the care of my child, the Management of Rosehill Day Nursery or their nominee may take photographs / record videos of my child, which may be used to promote the company. The photographs/ videos will be used for the purpose of advertising in a local paper, on the company website, social media sites, fund raising events, our Interactive learning diary application and sites internal and external displays. They may also be used as evidence for staff training and for evidence required by OFSTED or to complete course work. No other use will be granted.Child ProtectionI hereby agree to you contacting the relevant authorities should you suspect any kind of child abuse without prior consultation. I also agree to the child protection policy, which the nursery operates. I have read and understand the policy fully.GDPR Data ProtectionRosehill Day Nursery’s GDPR data protection form can be downloaded from our policies page.I hereby acknowledge that I have read and understood the Nursery’s privacy notice for Employees, Children and Parents.Uncollected Child PolicyI understand and agree to the Uncollected child policy and accept the consequences if I fail to collect my child, or arrange for an appropriate adult to collect my child. I am aware that Social Services may be called for failure to collect my child.Emergency Treatment ConsentI hereby agree to the Management and staff of Rosehill Day Nursery to administer any emergency treatment necessary for my child. This could also include contacting the emergency services, should the situation prevail, or transport to emergency care if we feel this would be the best option for your child. Please advise of any cultural or religious beliefs, should we need to contact the emergency services. Do you give permission for your child to have sweets & biscuits on special occasions *YesNoDo you give permission for your child to have their teeth brushed on a daily basis *YesNoDo you give permission for your child to have face paint on occasions *YesNoDo you give permission for your child to interact with animals on occasions *YesNo How did you hear about us? This form once signed completes a contract between Parent/Carer and Rosehill Day Nursery LimitedA non-refundable registration fee of £50 is required when this form is submitted for us to allocate the sessions you require for your child. If we are unable to offer the desired sessions, it will be refunded.Fee’s are to be paid in advance of childcare via bank transfer (NO CASH OR CARD) Account Name: Rosehill Day Nursery Limited Sort Code: 20-18-47 Account Number: 93839885Full payment of your booked session is due, regardless of drop off and pick up times. Your child must be dropped off and collected within the pre-booked hours to avoid additional charges, and to comply with ratios.Sessions booked but not attended are still chargeable. – e.g. off due to sickness, holidays or occasional days off. From the time of booking a contracted day i.e. a Monday you are guaranteed this place for your child/ren every Monday. An invoice will be raised for each contracted day and the fee is payable in advance.No refunds or concessions due to late drop off, or early collection. All parents/carers are requested to make sure that their child/ren are collected by 6.00 p.m. The nursery is not insured to care for children after this time. All nursery staff are paid up to 6.00 p.m. so please make sure you have collected by this time. If you are unavoidably delayed please contact us ASAP. If a parent/carer is late to collect their child/ren a fee will be charged for each late collection (please see separate sheet for costs).Pre-arranged late collections are available when organised in advance if staff are available. Costs available upon request.Refunds are not given for sickness, occasional days off or holidays, or any other unexpected days off taken.Our fees are calculated based on 48 chargeable weeks. We are closed for 2 weeks over Christmas and New Year. The remaining 2 weeks holiday can be taken at your discretion throughout the year.Children who arrive late on trip days will not be given a refund of fees paid for the trip, or the daily session fee.4 weeks-notice with full pay must be given to terminate or change your contract. If you require an additional contracted day we will try and accommodate you if possible. Please try and give as much notice as possible for any additional days required. A contracted day can only be swapped in exceptional circumstances please do not ask for days to be swapped continually. Please note a swapped day may be charged for in addition to the contracted day.If 2 payments are missed you will automatically be charged the late payment fee per week until your payment is up to date. (Please see separate sheet for costs)Monthly payment must be made on the 1st of each month.Fees include all meals, snacks, formula for infants, nappies and day trips.Any unexpected closure will be managed very carefully, with parents being kept informed of all necessary steps we may need to take. Please see associated policy.Your child must arrive prior to 8.45am to receive breakfast.For any child claiming Government funded hours, a fee would be payable for all consumables.If your child has any sickness or diarrhoea, they must stay away from the nursery for 48 hours from last episode.If your child becomes unwell within our care we would ask that your child be collected within 1 hour of the phone call.We will be closed over the Christmas period, dates are confirmed annually.Nursery closures due to Bank Holidays, fees will not be charged.I have read and understand the policies and procedures of Rosehill Day Nursery Limited and hereby agree to undertake and adhere to the policies as written. I accept that by submitting this form, I undertake to follow the policies and procedures in full, and failure to do so could result in my child being removed from the nursery.The Nursery reserves the right to amend and change any of the Nursery’s terms and conditions.On your next visit to Rosehill Day Nursery a Parent / Carer signature will be required to authorise this form and complete the contract between Parent/Carer and Rosehill Day Nursery Limited.Parent / Carer Signature * Please sign the box below to authorise this form and complete the contract between Parent/Carer and Rosehill Day Nursery Limited. If you are unable to sign below then you will be required to sign the document on your next visit to Rosehill Day Nursery.