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					                                          REGISTRATION FORM

Date:   ______________________                                         Application number: _________________

 1.     CHILD INFORMATION

        Name as in Passport: _______________________________________________________________________

        Nick name of the child (as called at home) : __________________________________________________

        Date of Birth:     _______/________/__________                 Place of Birth: _____________________

        Age / Sex: ___________ / __________                            Passport Number : ________________

        Nationality : _______________________________                  Religion:        _____________________

 2.     FAMILY INFORMATION

        Father’s Name:          _________________________              Nationality: ________________________

        Mother’s name:          _________________________              Nationality: ________________________

        Brothers’ and Sisters’ name and date of birth:

        Name: ______________________________________                   Date of Birth _______________________

        Name: ______________________________________                   Date of Birth _______________________

 3.     CONTACT DETAILS

        HOME ADDRESS:
        Bldg. / Apt/ Villa Name: _____________________________________________________________________

        Flat /Villa /Number: _______________________                   Street:          ______________________

        P.O.Box:                _______________________                Emirate:         ______________________

        TELEPHONE NUMBERS:

        Res. No.:        ___________________

        (Father) Office: ______________                                Mobile: _____________

        (Mother) Office: ______________                                Mobile: _____________

 4.     AUTHORISED PERSONS TO COLLECT YOUR CHILD FROM NURSERY

        Name (1):        ______________________________      Mobile No.          ____________________________

        Name (2)         ______________________________      Mobile No.          _____________________________

For Office Use:

Date of Admission:       __ /____/____         Admission Number:__________              Section: ____________

Receipt No.:____________                       Signature:___________
                                    MEDICAL QUESTIONNAIRE


1. CHILD INFORMATION

Name of the Child:    ___________________                Birth date: (dd/mm/yy): ______________

2. HAS YOUR CHILD RECEIVED THE FOLLOWING VACCINATIONS?

DPT/POLIO (2 months)          YES          NO             DPT/POLIO (18 months)      YES     NO
DPT/POLIO (4 months)          YES          NO             DPT/POLIO (school entry) YES       NO

DPT/POLIO (6 months)          YES          NO              BCG                       YES     NO

MEASLES (8 months)            YES          NO              HEPATITIS A               YES     NO
MMR (15 months)               YES          NO              HEPATITIS B               YES     NO

3. DOES YOUR CHILD HAVE ANY

a)   VISION IMPAIRMENTS?                                          YES           NO
     Give details, if YES:

b)   HEARING DIFFICULTIES?                                         YES          NO
     Give details, if YES:

c)   KNOWN ALLERGIES?                                              YES          NO
     Give details, if YES:

d)   KNOWN FOOD ALLERGIES?                                         YES          NO
     Give details, if YES:

e)   RESPIRATORY DIFFICULTIES?                                     YES          NO
     Give details, if YES:

f)   REGULAR MEDICATION?                                           YES          NO
     Give details, if YES:

g)   OTHER HEALTH PROBLEMS?                                        YES          NO
     Give details, if YES:

5. CHILD’S FAMILY DOCTOR INFORMATION

   Doctor’s Name: _______________________
     Telephone Numbers:
   Emergency:       ______________   Office No.: _______________                Mobile No. ____________
6 ADDITIONAL INFORMATION :


We hereby confirm that all the above details and information provided by us is accurate.

Name of the Parent:____________________    Signature:    ______________ Date:   ___/__/___
                               TERMS AND CONDITIONS
1. OPENING HOURS:

        The nursery is open Sunday to Thursday between the hours of 8:00 am and 12:30 pm.
         Day care facility is available from 7:00 am to 7:00 pm. The Nursery will remain closed
         for public holidays.
        The office working hours are Sunday to Thursday from 8:00 am to 2:00 pm

2. REGISTRATION REQUIREMENTS:

        Four (4) recent colour passport sized photographs;
        Two (2) copies of your child's passport and visa;
        Two (2) copies of the child's Father's and mother’s passport + visa page.
        Two (2) copies of your child's birth certificate;
        A photocopy of your child's immunization records;
        Completed registration and medical forms as well as signed "terms and conditions"
         approval slip;
        Registration fee of Dhs.150/- (a non refundable deposit)
        A medical fees of Dhs.200/- is payable annually.

3.       FEES AND DEPOSIT:

        Your child’s registration is a commitment from both parties, Parents and Nursery. If
         you go on vacation with your child in school time or, if your child is ill or late in joining
         the Nursery, no refunds can be given or discounted from the monthly Fees.
        In the eventuality of family relocation, we regret we will be unable to refund the
         current month fees, but any outstanding post dated cheques will be returned.
        Medical Fees are payable per annum at the beginning of each school year and are non
         refundable.
        School fees are payable in advance by the 5th of every month. Bank, Company Cheques
         and Cash are accepted means of payment for fees.
        A one-time only, non-refundable registration fee of Dhs. 150 is due as your child
         enters the nursery;

4.       ARRIVALS AND DEPARTURES

         Children must be brought to and collected from the main Nursery entrance only. No
         child should be left or taken without a staff member being informed. Collection of
         your child is only to be made by those persons authorised by you and registered with
         the Nursery. This is for the safety of your child.
5.   MEDICATION AND ILLNESS

     The child’s parent should inform the nursery of anything with respect of the child’s
     health.
     We have strict guidelines concerning infection control and illness within the Nursery.
     Please find below the following listing of signs and symptoms of infection in children
     that will serve as attendance exclusion criteria:
     •   Fever (greater than 101°F or 38.3°C)
     •   Rash with or without fever
     •   Diarrhoea
     •   Vomiting
     •   Unusual tiredness
     •   Poor feeding
     •   Persistent crying or irritability
     •   Breathing difficulties or persistent coughing
     •   Yellow skin or eyes
     •   Conjunctivitis or eye infection


6.   ALTERATIONS AND AMENDMENTS

     The parent/guardian undertakes to inform the Nursery in writing of any changes to
     the following:
     •   Address
     •   Telephone numbers
     •   Authorised persons
     •   Emergency contacts
     •   or any changes to similar information
7.    PERMISSION

      A)     The parent has no objection in allowing us to seek medical advice or aid from our
      school Doctor or Hospital depending on the circumstances and situation, in case of an
      emergency. If you do not accept this condition then it should be discussed with the
      Director and written instruction on the procedure to be followed should be agreed
      upon, documented and signed by parents, the Director and class teacher.
      B)     Incase the child is ill and if you require us to administer any medication to your
      child, please proceed to the office to fill in an illness report detailing instructions and
      permission to administer the medicine and for safe storage. Do not send medicines in
      school bags.
      C)     The parent has no objection in taking their child for short field trips.      Prior
      circulars will be sent to the parent regarding the trips.
      D)    The parent has no objection in their child being photographed and such
      photographs will be used in internal curriculum displays and on Butterflies Nursery
      advertising materials.


8.    TERMINATION

      One month written notice is required for the cancellation of your child’s place at the
      Nursery.
      Please note: If we at Butterflies Nursery feel that it is in your child’s best interests,
      not to continue with our program, then we are eligible to cancel the place with
      immediate effect.


We hereby accept the above terms and conditions set by Butterflies Nursery.


For

Name of Child _________________________ Admission No.__________


Father’s Name _________________________             Signature ______________


Mother’s Name _________________________             Signature ______________
Date:__________




                               CHECK LIST FOR REGISTRATION


       1.   Four (4) recent colour passport sized photographs

       2.   Two (2) copies of your child’s passport and visa

       3.   Two (2) copies of the child’s father’s passport and visa

       4.   Two (2) copies of the child’s birth certificate

       5.   One (1) copy of the child’s immunization records

       6.   Completed “Terms and Conditions” approval slip

       7.   Completed “Registration Form”

       8.   Completed “Medical Questionnaire”

       9.   Registration Fee of Dhs. 150

      10.   Medical Fee of Dhs. 200