Cippenham Nursery School

Registration Form

Please ensure both the Registration Form and the Short Consent Form (Appendix H) is submitted at the same time.

Please note: We are only able to offer a place if we have spaces available.

Registration Form

Please fill out the form below to register with Cippenham Nursery

Child's First Name

Child's Last Name

Child's Gender

Child's DOB

Are you seeking asylum?

If seeking asylum, please tell us when your child arrived in this country:

Which funding are you looking for?

Please tick which session you would prefer at Cippenham Nursery

Full Adress

Postcode

Mother's Full Name

Mother's Contact Number

Mother's Email

Father's Full Name

Father's Contact Number

Father's Email

Does the child have any siblings?

Have any siblings attended Cippenham Nursery School?

Siblings DOB & School Attending

Does your child have a Child Protection Plan?

Languages spoken by child

Languages spoken by parents

Does your child attend any other childcare provision? Please name (example: Childminder, Nursery Class, Private Nursery, Day Nursery, Pre-School, Nursery School).

Does your child have any of the following? Allergies, Hearing / Eyesight Problems, Speech and Language Difficulties, Other Health Problems

Is there anything you think we need to know about your child or family (e.g. family setup, additional needs)? Please provide details.

PLEASE ENSURE YOU COMPLETE THE SHORT CONSENT FORM (APPENDIX H) BELOW

Short Consent Form (Appendix H)

I confirm that I am the legal parent/carer for the child named below and that the information on this form is correct. I agree that you may use the information I have provided to process my claim for a free early education place and to contact other sources, as allowed by law, to verify my initial and ongoing entitlement. I agree that the information may be used to assess further benefits for my child and my child’s school (or other setting), ensure accuracy of records across the local authority and the check against fraud. I agree that my chosen early years provider may share information about my child’s progress as part of ongoing research to support the development of services for young children in Slough. Under the Data Protection Act 2018, we are required to gain your permission to keep personal details for you and your children on our database. Slough Borough Council and its agents may share this information with government and local authority departments and other authorised organisations for administrative, statistical and research purposes. For further information please visit: Slough Data Protection Completing this form and signing it gives us your informed consent. If you are unable to access the provided links or wish to submit a query in relation to fair processing, please contact the data protection officer at DataProtectionOfficer@slough.gov.uk I have read and understood the statements above and would like to apply for a free early education place for my child.

Child's First Name

Child's Last Name

Child's DOB

Parents National Insurance Number

11 Digit Unique Code

Print Name (Parent)

Parent's Signature (Please put x in space) - You will need to sign this in person when you come to the office)

Date

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Cippenham Nursery School

Registration Form

Registration Form

Short Consent Form (Appendix H)

Cippenham Nursery School

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