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Springer’s Registration Form
Information submitted with this registration form will be treated with the strictest confindence and will comply with GDPR
Child's legal name
Child's preferred name
Address
Date of Birth
Please select the sessions you require
Monday
Full day (8:30am - 5:30pm)
Morning (8:30am - 1pm)
Afternoon (1pm - 5:30pm)
After School Club (1:30 - 5:30pm)
Tuesday
Full day (8:30am - 5:30pm)
Morning (8:30am - 1pm)
Afternoon (1pm - 5:30pm)
After School Club (1:30 - 5:30pm)
Wednesday
Full day (8:30am - 5:30pm)
Morning (8:30am - 1pm)
Afternoon (1pm - 5:30pm)
After School Club (1:30 - 5:30pm)
Thursday
Full day (8:30am - 5:30pm)
Morning (8:30am - 1pm)
Afternoon (1pm - 5:30pm)
After School Club (1:30 - 5:30pm)
Friday
Full day (8:30am - 5:30pm)
Morning (8:30am - 1pm)
Afternoon (1pm - 5:30pm)
After School Club (1:30 - 5:30pm)
Persons with the Parental Responsibility i.e Mother, Father or Guardian
First Person
Name
Address
Mobile Number
Work Telephone
Home Telephone
Email Address
Doctor's Name
Doctor's Address
Doctor's Telephone
Doctor's Email
Second Person
Name
Address
Mobile Number
Work Telephone
Home Telephone
Social Worker Name (if applicable)
Social Worker Address
Social Worker Telephone
Social Worker Email
Details of those authorised to collect your child/children from us
First Person
Relationship to child
Telephone Number
Second Person
Relationship to child
Telephone Number
Third Person
Relationship to child
Telephone Number
Emergency Contact information
Note: If the name of the contact person changes, please inform the manager.
Doctor's Name
Doctor's Telephone
Doctor's Address
Name
Telephone
Address
Immunisation
Please check the box if the child has been immunised for the following
Diptheria/Tetanus/whooping cough
Polio
Measles/Mumps/Rubella
Pre-school Booster
HIB
Does your child attend hospital for any reason?
Is your child on regular medication of any kind?
Is your child on a special diet?
Does your child suffer from any allergies?
Does your child have any problems with sight/hearing/speech?
In the event of a medical emergency do you consent to your child being transported to hospital by a member of our staff?
No
Yes
Any other relevant medical information?
Register