Independent School Berkshire, Holme Grange Wokingham, UK

Your Child

Child's name*

First Surname

Gender*

Date of Birth*

Nationality*

Ethnicity*

Religion*

Language spoken at home*

Additional languages*

Attendance Preference*

What sessions are you proposing? Although we cannot guarantee these as it will depend on space in each session.

Proposed term and year of entry*

Have you registered your child's name at any other nurseries and if so, which?*

First Parent / Legal Guardian

Title*

Name*

First Surname

Relationship to child*

Telephone*

Mobile*

Email*

Home address*

Street Address City County / State / Region ZIP / Postal Code Country

Does the child live here?

Yes
No
Divided between parents

Occupation*

Employer*

Second Parent / Legal Guardian

Title*

Name*

First Surname

Relationship to child

Telephone*

Mobile*

Email*

Home address*

Street Address City County / State / Region ZIP / Postal Code Country

Does the child live here?

Yes
No
Divided between parents

Occupation*

Employer*

Other people with parental responsibility

Please provide the name(s) and current address(es) of any other person with parental responsibility (i.e. legal responsibility) for the above named child. Their consent to the child attending the School will be required if an offer of a place is made.

Title

Name

First Surname

Relationship to child

Address

Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country

School Connections

Connections with the School (Please mention here the names of any members of the family attending the School or registered for entry; or any other connection with the school)

Please indicate how you first heard of the School*

Other - please give details of how you first heard of the School*

Please fill in this answer if you have selected 'Other' in the question above

Present Nursery (if attending)

Please state the name and address of the present nursery

Please state the dates attended at the present nursery

Additional Information

Details of sibling(s)*

Home / Living arrangements*

Are there any home / living arrangements that we should be aware of to ensure the health, safety and wellbeing of your child whilst in our care?

External Agencies*

Are there any external agencies involved with the care / wellbeing of your child?

Yes
No

Please give details

Confidential Information Section

It is essential that you provide details of any medical condition, health problem or allergy affecting your child; any learning difficulty, disability, or special educational need of your child; as well as any behavioural, emotional and/or social difficulty (diagnosed or undiagnosed) using the text box below. Please email the School's Registrar, Mrs Julia Braithwaite, with as much detail as possible, including any medical reports and assessments.*

Declaration

Declaration: - I/ We request that our child named above is registered as a prospective pupil. - I / We understand that the School may obtain, process and hold personal information about me / us which may include financial information provided by me / us or by any licensed credit reference agency of information contained in any court orders, petitions or proceedings. - I/ We understand that the School may also obtain, process and hold personal information about our child which may include sensitive information such as medical details, and I / we consent to this for the purposes of assessment and, if a place is later offered, in order to safeguard and promote the welfare of the child. - I / We confirm that we have either enclosed a cheque for or paid by bank transfer of £200.00 being the non-refundable Registration Fee together with this Registration Form signed by me / us.

First Parent / Legal Guardian signature*

Second Parent / Legal Guardian signature*

Bank Details and Fee*

I / We have paid the £200 non-refundable registration fee

I / We have sent £200.00 by bank transfer to Holme Grange Ltd, sort code 60-24-21, account number 67352634.

Nursery Registration Form

Nursery Registration Form

Your Child

First Parent / Legal Guardian

Second Parent / Legal Guardian

Other people with parental responsibility

School Connections

Present Nursery (if attending)

Additional Information

Confidential Information Section

Declaration

Bank Details