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ADMISSION FORM FOR WINYATES PLAYGROUP

To be completed in pen or typed by the parent and handed to the supervisor

 

Child’s name...........................................................................................Date of birth……............................

Home address.........................................................................................Post Code….................................

Mother’s name.............................................................................................Tel no.........................................

Mother’s contact address...............................................................................................................................

Father’s name..............................................................................................Tel no.........................................

Father’s contact address................................................................................................................................

Who & where to contact in an emergency.....................................................................................................

Name of person(s) who will collect child........................................................................................................

Name of person or body legally responsible for the child...............................................................................

Child’s doctor...............................................................................................Tel no.........................................

Address...........................................................................................................................................................

Immunisation / vaccinations............................................................................................................................

Please Confirm :-.....Meningitis (Y/N)?.....MMR (Y/N)?    

Infectious illnesses.............................................................................................................................

Health visitor.........................................................................................................................................

Any special diet, cultural requirements, allergies, health problems etc.

........................................................................................................................................................................

Anything else the group should know about your child

....................................................................................................................................................................

 

Signed............................................Name.............................................. Date.......................

 

Enrollment Date (Playgroup supervisor).............................................

Winyates Playgroup Ltd, Unit 11 Winyates Centre, Redditch. B98 0NR.