Little Gems Day Nursery :: DayCare Pre-School Newham, London

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Online Registration Form

Child's Details

Child's Fullname

Child's Prefered Name

Gender

male female

Home Address

Post Code

Home Tel No

Mother		Father
Fullname		Fullname
Workplace Address		Workplace Address


Post Code		Post Code
Workplace Tel No		Workplace Tel No

Emergency Contacts

First Emergency Contact		Second Emergency Contact
Fullname		Fullname
Address		Address


Post Code		Post Code
Tel No		Tel No

Authorised Persons

If you wish to keep your child at our nusery, please provide details of who is authorised to collect your child. Children will only be allowed to leave with people named on this form or using a password.

Password

First Authorised Person		Second Authorised Person
Fullname		Fullname
Address		Address


Post Code		Post Code
Tel No		Tel No

Child's Doctor

Doctor
Fullname
Address


Post Code
Tel No

Is your child taking any prescribed medication No Yes

If Yes please provide details

Is your child taking any prescribed medication No Yes

If Yes please provide details

Child's Language/Ethnicity

Language Spoken at Home

What is Your Ethnic Background

Childcare Requirements

Monday	Tuesday	Wednesday	Thursday	Friday

Do you have a mainstream school in mind for your child yet? if so please state

Additional Comments (please use this space to provide us with any further information):

I Agree that I have read and understood the Precious Self & Little Gems Policies & Procedures and will Adhere to them as necessary

Download Registration Form

Choose from either Word or PDF formats:

Please send to us by either:
email: admin@little-gems.net

fax: 0208-536-2809

Or post to:	Precious Self & Little Gems
	147 Station Road
	Forest Gate
	London E7 0AE

Ofsted
Registration
Number: EY299816