Nursery Enrolment Form Please Choose Nursery: * —Please choose an option—Ashbridge NurseryAshbridge On RibbleThe FledglingsMaxy Farm Full Name of Child: * Date of Birth (DD/MM/YYYY): * Gender: * MaleFemale Address: * Postcode: * Telephone: * Email: * Additional Address (if child lives in two or more households): Postcode: Name & Age of Siblings: PERSONAL INFORMATION (Please include details of ethnic background and if English is an additional language, please state what is the first spoken language and details of any other languages spoken.) Ethnic Background: Other Information: MEDICAL INFORMATION 1. Name of Child’s Doctor: Telephone Number: Address: Postcode: 2. Details of Medical Condition, Disabilities, Allergies etc: None known 3. Are all standard immunisations up to date? YesNo Additional vaccinations: 4. Special requirements regarding food (Please state reason on medical condition or religious grounds only): No special requirements *Please note that Allergen information is available on request. CONTACT INFORMATION (Please include name, address and ALL appropriate telephone numbers (landline & mobile) and email addresses and ensure all contacts consent to their personal details being shared with us.) PARENT/GUARDIAN 1 Title: —Please choose an option—MrMrsMissMsOther Name: Address: Postcode: Phone Number: Mobile Number: Email Address: Hold Legal Responsibility for the Child? YesNo Place of Work: Work Number: PARENT/GUARDIAN 2 Title: —Please choose an option—MrMrsMissMsOther Name: Address: Postcode: Phone Number: Mobile Number: Email Address: Hold Legal Responsibility for the Child? YesNo Place of Work: Work Number: THIRD CONTACT Title: —Please choose an option—MrMrsMissMsOther Name: Address: Postcode: Phone Number: Mobile Number: Email Address: Hold Legal Responsibility for the Child? YesNo Place of Work: Work Number: DESIGNATED BILL PAYER SELECT BILL PAYER Parent/Guardian 1Parent/Guardian 2Other If Other: Title: —Please choose an option—MrMrsMissMsOther Name: Email: Contact Number: PLEASE TICK ATTENDANCE SESSIONS REQUIRED MONDAY Full dayAMExtended sessionPM TUESDAY Full dayAMExtended sessionPM WEDNESDAY Full dayAMExtended sessionPM THURSDAY Full dayAMExtended sessionPM FRIDAY Full dayAMExtended sessionPM I / We wish to be considered for the opportunity of a place at Ashbridge Independent School at the appropriate time: YesNo I/WE REQUEST A PLACE FOR MY/OUR CHILD TO ATTEND ON THE SESSIONS MARKED ABOVE AND UNDERSTAND THAT: A non-refundable deposit of £100 paid by cash, cheque, credit card or bank transfer is required to secure the place. A direct debit mandate must be in place and fees are due and payable in advance and are payable only by monthly direct debit or childcare vouchers/tax free childcare Full fees are payable for all absences, holidays and Bank Holidays. An administration fee pay be charged for extra sessions booked. If a place is to be terminated, 4 weeks’ advance notice is required in writing. Sessions booked can only be changed if 4 weeks’ advance notice is given in writing. Sessions booked may not be exchanged in any circumstances. Ashbridge reserve the right to change or amend regulations, policies and procedures as necessary. A fee review also takes place annually. I/we give permission for staff to call for emergency assistance or take my/our child to hospital if necessary. I/we understand that access to the following policies, procedures and protocols is available through the company website or as hard copy on request: Admissions, Behaviour, Exclusion, SEN, EAL, Curriculum, Anti-Bullying, Health and Safety, First Aid, Complaints and Privacy Notice. In addition, the latest inspection reports are also available. I/We confirm that we have read and understood the contents of the School Enrolment Form and the Terms and Conditions. I/We agree to be bound by the Terms and Conditions which consist of this School Enrolment Form, the Terms and Conditions available on the website, and any of the school’s policies and procedures which are in place from time to time. I/We confirm that they details set out in this School Enrolment Form are true and accurate in all respects. I/We will provide the school with a copy of the child’s birth certificate. I/We give permission to the school, its employees and agents to share information relating to my/our child with Children’s Social Care and other agencies responsible for protecting children as the school deems appropriate. Educational outings may take place away from school. I/We give permission for staff to take my/our child on outings. YesNo I/we give permission for photos/videos to be taken of my/our child for use in their online Learning Journal and understand that these photos/videos may be visible in the online Learning Journals of other children, such as in group activities or in the background. YesNo I/we give permission for photos/videos to be taken of my/our child for promotional purposes including printed materials, website, social media and local and national press, whilst attending Ashbridge or at a later stage. YesNo I/We wish to apply for my/our child to attend from: Signed: Name: Date: Signed: Name: Date: PREVIOUS NURSERY/SETTING(S) ATTENDED HOW DID YOU HEAR ABOUT US? BY SUBMITTING THIS APPLICATION YOU AGREE TO BE BOUND BY THE NURSERY TERMS AND CONDITIONS WHICH CAN BE VIEWED HERE OR FOR THE FLEDGLINGS VIEWED HERE AND BY ASHBRIDGE REGULATIONS, POLICIES AND PROCEDURES. I understand the completion of this form does not guarantee a place at the nursery, and that a place will not be offered until the registration fee of £100 has been paid and the application has been approved by a representative of Ashbridge Independent School and Nursery.