Butterflies Pre-School Registration Form

Child’s Details

Has your child been immunised?

Yes

If yes, please state

Does your child have any difficulties of disabilities?

Yes

If yes, please describe and If any outside agencies are involved please list here

Has your child any allergies?

Yes

If yes, please list here.

Doctors Name and Address

Doctors Telephone Number

Parent/Carer Details - Please include every parent and address (if different from the above)

Relationship to Child

Emergency contact details if different to the above

Relationship to Child

In the event of a “stranger” to the staff of Butterflies collecting my child, I understand that where at all possible I will endeavour to inform the Team Leader (Jeni) and I understand that a “stranger” must use my password to collect my child.

Please read and tick all

I give permission for a first aider to administer first aid to my child should the need arise.

I permit a member of staff to apply sun ream from a named bottle of sun cream to my child (supplied

I have read the policies of Butterflies Pre-School and Parent Pledge and will adhere to them.

I agree to all set out in the registration and confirm all the details are correct.

Please read and tick all that apply

My child is eligible for working parents 30 hour funding

My child will be funded by universal 3 year old funding 15 hours.

My child is under the two year old 15 hour code which must be obtained from Croydon.

My child will be self funded

Days Required

Consent for information storage and information sharing:

By registering your child this form will be securely stored electronically which will be accessible to Butterflies Pre-School employees subject to your consent.

In order to provide the most appropriate support to your child, it may be necessary for us to share some of this information with other professional services. All information supplied is processed and secured stored in accordance with the General Data Protection Regulation, and we will only share the minimum information needed to enable those teams and or agencies to provide appropriate support. Your information will be kept for a maximum of seven years unless you revisit or withdraw your consent. You can withdraw your consent at anytime by contacting us.

In certain situations, Butterflies Pre-School may be required by law to share your information to prevent harm to your child. If there are any concerns about the safety and / or wellbeing of a child local safeguarding procedures will be followed.

I understand the information recorded on this form will be processed and stored in accordance with the General Data Protection Regulation; and will be accessible to Butterflies Pre-School, and used for the purpose of providing support services to me

I would like to receive information about Butterflies Pre-School services by email.

Yes

No (opt-out, this may affect the level or type of support we can provide)

Your Signature

Drawing mode selected. Drawing requires a mouse or touchpad. For keyboard accessibility, select Type or Upload.

I have been informed, understand and agree that some of my/ my family’s information may be shared with other professional services for the purpose of providing the most appropriate support to me and my family.

Yes

No (opt-out, this may affect the level or type of support we can provide)

Butterflies Pre-School Registration Form

Child’s Details

Has your child been immunised?

Yes

If yes, please state

Does your child have any difficulties of disabilities?

Yes

If yes, please describe and If any outside agencies are involved please list here

Has your child any allergies?

Yes

If yes, please list here.

Doctors Name and Address

Doctors Telephone Number

Parent/Carer Details - Please include every parent and address (if different from the above)

Relationship to Child

Emergency contact details if different to the above

Relationship to Child

Please read and tick all

I give permission for a first aider to administer first aid to my child should the need arise.

I permit a member of staff to apply sun ream from a named bottle of sun cream to my child (supplied

I have read the policies of Butterflies Pre-School and Parent Pledge and will adhere to them.

I agree to all set out in the registration and confirm all the details are correct.

Please read and tick all that apply

My child is eligible for working parents 30 hour funding

My child will be funded by universal 3 year old funding 15 hours.

My child is under the two year old 15 hour code which must be obtained from Croydon.

My child will be self funded

Days Required

Consent for information storage and information sharing:

By registering your child this form will be securely stored electronically which will be accessible to Butterflies Pre-School employees subject to your consent.

I would like to receive information about Butterflies Pre-School services by email.

Yes

No (opt-out, this may affect the level or type of support we can provide)

Your Signature

Drawing mode selected. Drawing requires a mouse or touchpad. For keyboard accessibility, select Type or Upload.

Yes

No (opt-out, this may affect the level or type of support we can provide)