ZEEBA NURSERY APPLICATION FOR ADMISSION Before completing this form, please carefully read the accompanying information: Complete using block letters Child’s Surname: .......................................................... First Names: .................................................. Surname as Registered at Birth: ................................... Date of Birth: ................................................. Child’s Permanent Home Address: ................................................................................................................... ....................................................................................... Postcode: ...................................................... Start Date: .................................................... Days required: ........................................................................................................................................ Names an ages of any siblings currently attending the setting: ………..................................................... Who has parental responsibility: ……………………………………………………………………………………………….………. Parent Child Resides with: ...................................................................................................................... If there is custody order in place please provides us with a copy of this. Nationality: ................................................................. Home languages: 1st.................................................... nd 2 ..................................................... Religion: ...................................................................... Any special requirements: ............................................................................................................................... MOTHER: First Name: .................................................. Surname: ..................................................... Place of Work name: ..................................................... Work Num: .................................................. Mobile Num: ................................................................. Home Num: ................................................. Email: .............................................................................. Mother’s signature: ............................................. Mother’s address (if different from child): ……………………………………………………………………………………….………. FATHER: First Name: ................................................... Surname: ..................................................... Place of Work name: .................................................... Work Num: .................................................. Mobile Num: .................................................................... Home Num: .......................................................... Email: ............................................................................. Father’s signature: ............................................... Father’s address(if different from child): …………………………………………………………………………………………...……….   Please indicate which email address should be used to receive Nursery invoices Please use BLOCK letters to complete ZEEBA NURSERY EMERGENCY CONTACTS – Please provide us with names and addresses of two responsible adults with a telephone who can be contacted in the event of an emergency if parents are unavailable. Please note, in the event of an emergency, attempts will always be made to contact the Parents/Carers in the first instance. Name: ............................................................ Address: ........................................................ .......................................................................................................................................................................... Tel no: ............................................................. Relationship to Child: .................................... Name: ............................................................. Address: ........................................................ .......................................................................................................................................................................... Tel no: ............................................................. Relationship to Child: .................................... HEALTH AND MEDICAL Medical Condition(s): ........................................................................................................................... Related Medication(s): ........................................................................................................................... Allergies: ........................................................................................................................... Related Medication(s): ........................................................................................................................... Any special dietary needs/ requirements (Please state): ............................................................................  Please note that a Health Care Plan needs to be completed for any allergies or medical conditions and that a Doctors letter need to be provided, regarding symptoms, treatment and medicine required PERMISSION FOR PHOTOGRAPHING YOUR CHILD From time to time we like to take pictures of the children doing activities for observation purpose. We would like your permission to use these pictures in their observation folders, on our website and on our bulletin board. We will never sell these pictures; we will use them exclusively for Zeeba Nursery purposes. ........... YES, I grant you permission to use photos of my child for observations, on Zeeba bulletin board and Zeeba website ........... NO, please do not take or use photos of my child ZEEBA NURSERY FEES AND PAYMENTS A fee of £350 is payable to secure a space on the waiting list at Zeeba Nursery, this fee is non-refundable should you decide not to take the space. The fee of £350 will be balanced against your last month’s fee, subject to a one month written notice at any time 2 months after the start date on the application. Your space at Zeeba Nursery will be confirmed 3- 6months before your start date. Zeeba Nursery reserves the right to return the fee if unable to provide a space. Please contact us one month before your start date to arrange settling dates at the nursery. The first month’s fee will be payable one week before the first settling day. st The monthly fee is reviewed yearly and might increase on the 1 of April. There is an additional fee for booked Early Mornings (07:30) and booked Late Pickups (18:30) and a Late Pickup Charge for pickups after 18:00. Any Extra Charges will be added to the following month’s fee. I hereby agree to all of the above: Signed by parent/guardian: …………………………………………………………………………………………………………. Date: …………………………………………………………………………………………………………. PARENTAL PERMISSION FOR ZEEBA DAY CARE – EMERGENCY TREATMENT In order for staff to ensure that your child receives the best and most appropriate care, attention and treatment should there be an emergency in the provision or while out on a trip you need to complete the below form. I agree to the registered person in the Nursery taking the necessary steps to ensure that my child ……………………………………………….. receives the best and most appropriate care and attention and treatment should there be an emergency or accident in the provision. I understand that the registered person or management team will make every effort to inform me of any emergency as soon as possible after the event but that they may have to accompany my child ……………………………………………….. to hospital in the case of a serious accident in my absence. I give permission for the registered person or management team to authorise hospital staff to administer essential treatment until my arrival. Signed by parent/ guardian ………………………………………………………………………. Date …………………………… ZEEBA DAY CARE POLICIES I have read, understand and agree to adhere to the Zeeba Nursery Policies as outlined in the Parent Handbook and Zeeba Nursery website which have been provided to me (www.zeebadaycare.co.uk). Signed by parent/ guardian ………………………………………………………………………. Date …………………………… ZEEBA NURSERY Office use only Child’s original Birth Certificate Proof of Address eg. Utility/council tax bill please tick when seen and copy taken please tick when seen and copy taken Print name of Manager/ Deputy Manager: ..……………………………………………………………………………… Signature of Manager/ Deputy Manager: ……………………………………………………………………………….. Date: ……………………………………………………………………………….. New applications- Managers Checklist Date Date Received Childs details registered on INM Details send to Accounts Welcome letter send Deposit received Settling in times arranged