Horizon Childcare Registration Form

This form is to be completed by the parent/ carer for each child. This form must be submitted to the Nursery Manger along with the registration fee of £40 to secure the space. Spaces are allocated on a first come first served basis. Please fill in as much information as possible and provide your child's birth certificate upon registration.

Child Information

Legal First Name *

Middle name/s

Legal Last Name *

Gender *

Date of birth *

Address 1 *

Address 2

City *

Post code *

Ethnicity *

Religious Affiliation *

First Language *

Is there a court order relating to this child? *

Yes

What days and times do you require childcare on? (Please note we have a 7 hour minimum booking per day to ensure our childcare is fully utilised.) *

When would you like this childcare to begin? *

How did you hear about our setting? *

What aspects of the setting made you join our nursery? *

Medical and Dietary Information

Dietary Requirements if applicable

Medical Needs if applicable

Doctors Information (Name, address and phone number) *

Additional Details

Health Visitor Name

Health Visitor Number

Social Worker Name (if applicable)

Social Worker Number (if applicable)

It is important that all the agencies who are working with a child work together to ensure better outcomes for that child. In order to do that, please identify any other agencies working with your child for example Family Support, Speech and Language Teams, Child and Adolescent Mental Health Services. Please list any agencies below:

Special Educational Needs - please use this box to inform us if your child has Special Educational Needs (i.e. has a Statement for Special Education Needs or an Education and Health Care Plan (EHCP) or is currently being Assessed)

Has your child previously attended/ currently attends another setting (school, childminder, nursery etc)? *

Yes

If so, please give details below, (include the name, address, phone number, person of contact and estimated time child has attended)

Do you give us permission to make links with the previous setting (if applicable)?

Yes

Parent/Carer Details

Parent/Carer 1

Do you have 'Parental responsibility' over this child? *

Yes

Title *

Forename *

Surname *

Mobile *

Do you live at the same address as the child? *

Yes

If the answer is no, please fill out your address here:

Home No. *

Email *

Occupation *

Work No. *

Place Of Work *

If English is not your first language, please state what is (this may include British Sign Language):

Do you need an interpreter *

Yes

What is your relationship to this child e.g. parent /foster parent/grandparent? *

Parent/ Carer 2 (if applicable)

Do you have 'Parent responsibility' for this child? *

Yes

Title *

Forename *

Surname *

Mobile *

Do you live at the same address as the child? *

Yes

If the answer is no, please fill out your address here

Home No. *

Email *

Occupation *

Work No. *

Place of Work *

If English is not your first language, please state what is (this may include British Sign Language) :

Do you need an interpreter? *

Yes

What is your relationship to this child e.g. parent/foster parent/grandparent? *

Family and Contact Information

We are required by law to hold the names, addresses and telephone numbers for people with responsibility for this child and anyone who may collect them from nursery. Please record all relevent information of this kind for contacts listed below

Please state the names of people with parental responsibility for your child *

Are these names the same as stated on the birth certificate: *

Yes

If different than the child's address, please state the parents addresses (this will relate to anyone named on the birth certificate who isn't listed below)

Siblings and dates of birth (if applicable)

Please state the names of all those living in the same household as your child (including parents, siblings, extended family, long-term visitors, lodgers) *

Please give the names, relation to child, addresses and telephone numbers for at least two additional emergncy contact numbers we can use if we are unable to get hold of you.

Contact 1: *

Contact 2: *

Contact 3:

Please set a password to use on collection: *

Permissions

Emergency Consent e.g. the nursery has permission to give/arrange emergency treatment including administering paracetamol based medication to prevent febrile convulsions in the event of a high temperature (over 39oc) *

Yes

Do you give consent for the nursery to use factor 30 suncream that will be provided? *

Yes

From time to time we would like to take pictures of the children for different uses. Please check the boxes of the following items you do give permission for: *

Promotional use on our own website

Promotional use on our partner websites (e.g. if we partner with another company)

Promotional use on our social media sites

None of the above

Data Protection

What we do with the information you have provided on this registration form.

Nurseries hold information on pupils and parents in order to run the education system, (ie to support the teaching and learning, to monitor and report on their progress, to provide appropriate pastoral care and to assess how well the nursery as a whole is doing *) and in doing so have to follow the GDPR laws 2018. This means, among other things that we must let you know how we handle your data and who has access to it.

From time to time the nursery is required to pass on some of this data to the Local Authority (LA), to another setting/school involved with the child, to the Department for Education (DfE), Department of Health (DH), Clinical Commissioning Groups (CCGs) and Local Area Teams (LATs), the Office for Standards in Education (Ofsted), Education Funding Agency (EFA), Skills Funding Agency (SFA) and other partnership organisations working with early years settings to provide a service to pupils.

Sharing information with others - As a nursery and wrap-around care provider it is necessary for us to collect personal information about you and your child. Sometimes we have to confirm or share information with other organisations. If we need to do this, we will make it clear to you on the forms you complete giving us the information. We will inform you before sharing any of yours or your child’s information. In some cases, a third-party organisation, such as a funding body, may require you to sign an agreement to allow your information to be shared e.g. on a funding form. Please read all paperwork thoroughly before signing, so that you know exactly how your information will be used.

Information - We will make sure that the information about you is accurate and up to date when we collect or use it. You can help us with this by keeping us informed of any changes to the information we hold about you.

Information security - We will keep information about you and your child secure. We will protect your information against unauthorised change, damage, loss or theft. All information collected on paper forms is kept locked away. Our computer, and tablets are password protected.

Keeping information - We will hold information about you and your child only for as long as the law says. After this, we will dispose of it securely.

Openness - We will tell you what kinds of information we hold and what we do with it.

Access and correctness - Whenever possible, we will let you see the information we hold about you and correct it if it is wrong.

In general - We will comply with the Data Protection Act 1998 and any subsequent legislation on information handling and privacy. We will do this through Horizon Childcare’s Data Protection Policy. We will help you with any questions or problems that you may have with the Data Protection Act 1998, the Human Rights Act 1998 or the Freedom of Information Act 2000. If we cannot help you, we will give you advice on where to write to get the information you may need.

Our Commitment - We will only collect information that is necessary for what we do. We will be fair in the way we collect information about you. We will tell you what we intend to do with the information about you. Where practicable, we will collect information directly from you. If we collect information about you from someone else, we will make sure you know that we have done this whenever possible.

Types of information we collect - Yours and your child’s full names; Your child’s date of birth; Your address; Your contact numbers and those of your emergency contacts; Your email address; Your child’s medical conditions; In some cases, your National insurance number.

While your child is with us we store information regarding: Their ongoing progress and development; photographs of them; Accident records; medication records.

*Please be aware that you are signing on behalf of all persons in regards to you children who may have information held with the nursery e.g. all parents and emergency contacts. Please be aware you are signing to acknowledge you responsibility to act on their behalf and inform them of this agreement

Terms and Conditions

By signing I am giving written consent that I have read and consent to data protection information (as above), terms and conditions and our policies and procedures (on the website). Horizon Childcare has the right to cancel my contract if I do not cooperate and adhere to policies and procedures, or Early Years Foundation Stage requirements, for which I will receive four weeks’ notice. I also understand that four weeks' written notice is required to end my child’s place at nursery and at least four weeks' usually childcare will be charged for upon Horizon Childcare's understanding I would like to cancel the place.

I understand that it is my duty as a parent to help keep the children of Horizon Childcare safe. For this reason, I will not bring items into the nursery that could hurt any other child. I will also not allow my child to bring items into the nursery that could cause harm to another child e.g. small toys. I understand that it is appropriate at certain tiems of the day that age groups will mix and for this reason it is highly important that all children's personal age-appropriate toys are left at home. I will not ask about other children who attend the nursery or seek to gain information about other children who may or may not attend the nursery. I will help to keep the premises safe and secure and will not grant access to anyone unless they are authorised by a member of the staff team. I will not seek to gain unsupervised access to any children in the nursery and will pass on all appropriate messages to help with the care and education of my child.

I am also giving written confirmation that I have filled in this form as accurately and honestly as possible giving as much information to the best of my knowledge. If any information has not been brought to the attention of the nursery upon registration Horizon Childcare will not be held liable. Any details missed from this form can compromise my child's level of care and education. If my child develops any dietary or medical needs after registration these will be communicated in writing to the Manager in order for the staff team to be informed.

I understand that Horizon Childcare is required to abide by the requirements of the Early Years Foundation Stage Statutory Framework. I will regularly ensure that the nursery has the most up to date information about my child and our family e.g. emergency contact numbers, allergies, medications, changes within the home and outside agencies such as social workers or childminders. I also understand that it is a requirement of each parent to be involved with my child's learning in and to assist the nursery in this matter including: being willing to attend meetings in relation to my child; adding observations from home to the Interactive Learning Diary system when possible; and engaging with my child at home to enhance their learning.

I understand that Horizon Childcare has a duty to complete assessments such as 2 year old checks. I understand that it is necessary for some of the data from 2 year old checks to be shared with the Speech and Language Team in Devon. For more information on this please speak to the office.

If my child is absent due to sickness, the nursery should be notified as soon as possible. If my child is unwell I will abide by the nursery exclusion periods and am aware that these are in place to reduce the risk of spreading illness or infection. I will respond promptly (within one hour) to phone calls from the nursery to advise that I need to collect my child due to illness. If my child becomes ill at nursery a member of staff will contact me or my emergency contacts. I will also follow the nursery’s strict medication policy if my child needs medicine whilst at nursery. If my child is unwell I understand there will still be a full charge for the nursery as the staff will already be on site.

Horizon Childcare operates a zero tolerance policy and will cancel my contract if I harass or intimidate any of the staff.

I understand that holiday periods booked in advance will be charged at the reduced rate of 50%. I understand that I must give a full weeks notice to receive the 50% discount.

Late Fees and early fees will apply if I bring my child into the nursery around their booking time without giving the nursery notice to amend staffing structures appropriately (7 days notice where possible).

I understand it is part of the nursery’s ethos to make links within the local community which also includes taking the children out on walks. I give consent for the staff to take my child on short trips within the community to enhance their learning experiences. Horizon Childcare will also plan various activities including, but not limited to, food tasting and cooking so I understand it is my duty to inform them of any allergies my child has to protect them from harm.

I understand that photographs and video footage of the children are taken and used for observation, assessment, training purposes, and displays within the nursery. I consent for my child being photographed and videoed for these purposes only. I understand it is also necessary for the Horizon Childcare to use my child's full name within the setting and it is my duty to inform them if there are any reasons why this might not be safe for my child. Separate permissions for photographs may be given e.g. social media. All photos of children will be stored and shared in line with General Data Protection Regulations (GDPR).

I understand personal information is kept about my child in line with the safeguarding and welfare requirements of the Early Years Foundation Stage and General Data Protection Regulations (GDPR). This information will only be shared with necessary staff and the local authority (Devon County Council) for the purposes of providing appropriate care for my child. Records are kept once children have left in line with Local Authority guidelines and some documents may be stored off site if permitted by our governing body Ofsted. When children are in receipt of additional funding, such as the Early Years Extended Entitlement or Childcare Tax Credits, data may also be shared with third parties as necessary, all of whom carry their own Data Protection Statements.

Sign: *

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