registration form

If you are registering more than one child, please use a different username for each registration

  • Username (this can be anything you like – you will need this to access your account with us)
  • Screen Name (please enter your child’s name here in the format Joe Bloggs i.e. first and surname)
  • Email address for all correspondence
  • Password (this can also be anything you like – again you will need this to access your account with us)
  • Confirm Password
  • Location
  • Child's full name
  • Known as
  • Date of Birth
  • Address
  • Postcode
  • Home Tel. Number (inc. area code)
  • School Attending/due to attend
  • School start date (if applicable)

    • Details of parents/parent the child lives with

  • Name (1)
  • Mobile (1)
  • Work telephone (1)
  • Email (1)
  • Name (2)
  • Mobile (2)
  • Work telephone (2)
  • Email (2)

    • Details of parent child does not live with (if applicable)

  • Name
  • Does this person have parental responsibility Yes / No
  • Address
  • Telephone number
  • Mobile
  • Work telephone
  • Email
  • Does this parent have legal access to the child? Yes / No
  • Relationship to child
  • Telephone number
  • Mobile
  • Name
  • Relationship to child
  • Telephone number
  • Mobile

    • Name of other people with permission to collect your child/children (must be over 16yrs old)

  • Please choose a security password (used in emergency if a person collecting a child is unknown to the setting)
  • Name
  • Relationship to child
  • Telephone number
  • Mobile
  • Name
  • Relationship to child
  • Telephone number
  • Mobile
  • Name
  • Relationship to child
  • Telephone number
  • Mobile
  • Name
  • Relationship to child
  • Telephone number
  • Mobile

    • Child’s Personal Details

  • Doctor
  • Address
  • Telephone number
    • Details of Immunisations
  • Are any of the following not up to date?
    Diphtheria, Tetanus, Pre-School booster, Measles, Mumps, H.I.B, Meningitis, Whooping Cough, Rubella, Polio
  • Details of any allergies
  • Medical problems
  • Medication requirements
  • Dietary requirements
  • What language is spoken at home?
  • What is the main religion of your family?
  • How would you describe your child’s ethnicity?
  • Are there any festivals or special occasions celebrated in your culture?
  • Does your child have any Special Educational Needs (eg speech, behavioural) or disabilities? Please give details
  • Please name any professionals involved with your child for example health visitor, speech & language therapist, social care worker
    Name, Agency and Telephone
  • If you have a social care worker please briefly detail their involvement. If your child has a care protection plan make a note here but do not include details

    • Other Childcare Arrangements

  • Does your child attend any other setting for childcare (eg nursery, child minder) Yes/No
  • Name of provider
  • Address
  • Telephone
  • Attendance (days & hours)

    • Where do you hear about La Maternelle?

  • Recommended by a friend/family member
    Internet
    Saw a banner with your details on
    One of my children already attend La Maternelle
    Other (please state)

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