Pre-Start Registration form

To be completed by parents/carers seeking to secure a place for their child/young person. We are happy to accept registration forms up to 12 months in advance of the start date, but ask parents to pay a deposit of £5.50 to secure a place. This is non-refundable unless the

Pre-School has ceased to operate at the time your child is due to start. We would be grateful if you could advise the Pre-School if you no longer require your place.

Child/young person’s name
Date of birth
Name of Parents/Guardians
Tel no. (home)		(Work) (Mobile)
Address


Postcode

Emergency contact

Name
Address
Tel

Childs Doctor

Name
Address
Tel no

Any special needs of child
Disability
Diet
Allergies
Behavioural Problems
Other
Requested Start Date (i.e. January 2005)

To help us with our promotional activity, please indicate how you heard about Southwell
Pre-School.

Advertisement/poster

Friend/family member

Other please state

Deposit paid