Little Stars Day Nursery   Enrolment Form

Please supply all the details requested and return the from to Catharine or Sue at "Little Stars Day Nursery", 39 Penn Hill Avenue, Penn Hill, Lower Parkstone, Poole, Dorset, BH14 9LU Please use Block Capitals

1.  Full name of Child.......................................................   Date of Birth...........................

Mothers Name......................................   Fathers Name....................................................

Home Address.................................................................................................................

Tel. No....................................

2.  Mother's Employer......................................................   Tel. No...................................

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

Father's Employer...........................................................   Tel. No...................................

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

Name of person to collect child ...................................................

3.  Child's Doctor............................................................   Tel. No...................................

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

Name of child's Health Visitor..............................................................

Address of Health Clinic....................................................................................................

Tel. No........................................

Immunisations/Vaccinations........................................................................................................................................

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

4.  Do you wish your child to attend Full or Part Time?.................................

If Part Time, please put ticks in the appropriate spaces:-               

5. Please give details of any special diets, allergies or health problems........................................................................................................................................

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

6.  Please can you answer the questions below so we can have a full picture of what your child is like.

Does your child have any particular habits (for example having a sleep during the day).........................................................................................................................................

How does your child relate to other people? (both adults and children) ..........................................................................................................................................

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

Does your child portray any particular moods or feelings which we should be made aware of? .........................................................................................................................................

Is there anything else we should know about your child?  If yes please give details ..........................................................................................................................................

Is your child an only child or does she/he have any siblings? ................................................................................................................

Please can we have an emergency telephone number where you, a friend or relative can be contacted during nursery hours? .........................................................................................................................................

Date I wish my child to start at the nursery.........................................................................

I wish for the child named above to start at Little Stars Day Nursery on the date above

Signed (Legal Guardian)..................................        Date..................................