Online Registration Form

Child Details

Childs Name*

Date of Birth*

Address*

Post Code

Home Tel Number*

Start Date*

Nationality

Religion

1st Language

School Details

School*

Class Teacher*

Parent Details

Mothers Name*

Mothers Address*

Mothers Telephone*

Mothers Employer*

Employers Tel No*

Fathers Name*

Fathers Address*

Fathers Telephone*

Fathers Employer*

Employers Tel No*

Contact Email Address*

Guardian who has parental responsibility

Name of person who holds legal guardianship of child*

Name of person who has parental responsibility*

Alternative Emergency Contact Details

Alternative Emergency Contact*

Telephone Number*

Relationship to Child

Named Person(s) who may collect the child

Name

Relationship

Telephone

Name

Relationship

Telephone

Name

Relationship

Telephone

Password for those who can collect

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