Spring Wellsprings

Registration Form

Child's Full Name:

Gender

Child's Date Of Birth

Address

Postcode

Nationality

Ethnicity

Religion

Home Language

Any additional Languages?

Parent/Carer information

Parent/Carer’s (1) Name *

Parent/Carer's Relationship to Child

Parent/Carer's Date of Birth

Parent/Carer's Address

Parent/Carer's Postcode

Legal Responsibility

YES

NO

Place of work

Mobile Tel

Work Tel

Email *

Funded Entitlement

Funding

2 year old Funding

3-4 Universal Funding

3-4 Extended Funding

30 Hour Code

Declaration

I have read and understood this form and the Terms and Conditions and agree to the contents. I understand that the nursery reserves the right to make amendments to this form and to its terms and conditions from time to time.

Signed Parent / Carer *

Clear

Date *

Spring Wellsprings

Website : https://www.actionforchildren.org.uk/