Cippenham Nursery School

Registration Form

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

Please Select Your Child's Gender

Child's DOB

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

Which funding are you looking for?

Full Adress

Postcode

First Contact Number

Second Contact Number

Mother's Full Name

Father's Full Name

Does the child have any siblings?

Have any siblings attended Cippenham Nursery School?

Siblings DOB & School Attending

If you are asylum seekers, please tick

Please tick which session you would prefer at Cippenham Nursery

Does your child have any of the following? Please leave details - Allergies

Does your child have any of the following? Please leave details - Hearing/Eyesight Problems

Does your child have any of the following? Please leave details - Speech and Language Difficulties

Does your child have any of the following? Please leave details - Other Health Problems

Is your child seen by any of the following? Please give names - Hospital/Doctor/Consultant

Is your child seen by any of the following? Please give names - Health Visitor

Is your child seen by any of the following? Please give names - Speech Therapist

Is your child seen by any of the following? Please give names - Teaching and Support Service

Is your child seen by any of the following? Please give names - Social Worker

Is your child seen by any of the following? Please give names - Dentist

Is your child seen by any of the following? Please give names - Other

Does your child have a Child Protection Plan?

Languages spoken by child

Languages spoken by parents

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

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? Please leave details

Please provide further information

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Cippenham Nursery School

Registration Form

Registration Form

Cippenham Nursery School

Our use of cookies

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