Simba

Child Details                      Preferred Start date: ­­­__________

 

Full name

 

 

Known As

 

 

Home address

 

 

 

 

 

 

 

 

Birthday (DD/MM/YYYY)

 

 

Religion and Nationality

 

 

Special dietary needs

 

 

Special diary dates

 

 

Celebrations to be avoided

 

 

Individual care requirements

 

 

Any further information

 

 

Immunisations

 

 

Carers Details

 

Mum/ Carer

 

 

Address

 

 

 

 

 

Home phone

 

 

Mobile phone

 

 

Work phone

 

 

E-mail address

 

 

Dad/Carer

 

 

Address

 

 

 

 

 

Home phone

 

 

Mobile phone

 

 

Work phone

 

 

E-mail address

 

 

Emergency and Medical Information

 

In case of emergency, contact

 

 

Emergency contact’s address

 

 

Emergency contact’s phone

 

 

Doctor’s name

 

 

Doctor’s phone

 

 

Doctor’s address

 

 

 

 

 

Allergy information*

 

 

Illnesses*

 

 

Current medications*

* Requires additional form

 

 


Attendance Schedule

Monday

Tuesday

Wednesday

Thursday

 

 Friday

Morning (8am -1pm)

 

 

 

 

 

Afternoon (1pm - 5.30pm)

 

 

 

 

N/A

School day (9am -3pm)

 

 

 

 

N/A

Full day (8am - 5.30pm)

 

 

 

 

N/A

Hourly (Please State)

 

 

 

 

N/A

Nursery lunch

 

 

 

 

 

Nursery High Tea

 

 

 

 

N/A

Forest School Session

3 + years

TBC

TBC

TBC

TBC

 

     N/A


Please note any parents wanting term time only should inform the office

Collection details (please state all individuals other than parent/carer allowed to collect your child). Photo ID required.

1. Name

 

Relationship

 

Phone number

 

2. Name

 

Relationship

 

Phone number

 

 

Schedule:

Due:

Method (circle)

Initial

 Monthly

1st of each month (split into 12 equal payments)

BACS, Standing Order, Vouchers

 

 

 Fees are payable during periods of absence such as holidays and sickness. Late payments will be charged and could result in your child’s place admittance being refused. Cancelation of a booked place requires one full calendar months’ notice in writing. Contract places are booked for a minimum term of 6 months. Parents wanting a short term space should use the ad hoc booking.

I have read and agree to the terms and conditions displayed on the website.

 

Signature:……………………………….

 

Print Name:……………………………………

 

Relationship to child:……………………………

 

Date……………………………………

Thank you for registering with Simba’s Den, we will be in touch to confirm your child’s place.

 

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