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					             Apple Trees Nursery, Waters Upton.

                                          Enrolment Form.

Child’s Name…………………………………………Date of birth…………………..
Parent/Guardian…………………………………………………………………………
Address…………………………………………………………………………………
………………………………………………………………………………………….
…………………………………Post code………………………’phone no.………..

Names and ‘phone numbers of 3 people to contact in case of emergency
……………………………………………………………………………………………
……………………………………………………………………………………………

Name of Doctor…………………………………………………………………………
Address and telephone number ………………………………………………………..
……………………………………………………………………………………………
……………………………………………………………………………………………
Details of Immunisation…………………………………………………………………
Do you give permission for treatment or advice in the event of an emergency? Y / N
Do you give permission for waspeze to be administered?                       Y/N
Do you give permission for sunscreen to be applied if necessary?             Y/N
Any medical information that we should be aware of i.e. epilepsy, diabetes,  Y/N
allergies?
Any religious or cultural dietary needs?                                     Y/N
Any other information we should be aware of e.g. any particular fears or     Y/N
traumas?
Do you give permission for supervised outings?                               Y/N
Do you give permission for photographs in the press?                         Y/N
Do you give permission for photographs on our website?                       Y/N

When would you like your child to start………………..leave………………………….
How many sessions?……………………………………………………………………..
Which sessions would you prefer? Mon / Tues / Wed / Thurs/ Fri (please circle)
Who will be collecting your child from nursery?..............................................................

Registration Fee - £20 (non refundable) Date paid………………………………………
                          (All cheques payable to J. Bishop)

Please see prospectus for session times. Fees payable one half term in advance.
                                No refunds for absences.


One half term’s notice must be given if the child leaves prior to expected leaving date.
Signature of Parent/Guardian

Date…………………………………….


                                   J. A. Bishop
  Apple Trees Nursery, Waters Upton Village Hall, Waters Upton, Telford, TF6 6NP
                                  07713 155822

				
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