Horsforth Registration formWe need some details about your child and family. We have a legal obligation to collect and process this information in accordance with The Early Years Foundation Stage (Welfare Requirements) Regulations 2012 and therefore we do not require your consent for the first section of this form. Where information to be supplied is voluntary or where we do need consent this is identified. The information provided will be kept in paper form and also Connect our computer software system and used for the purpose of maintaining appropriate contact details and for the safety and well-being of your child. Should you have any questions regarding the above please discuss this with management.Requested Start Date *dd-mm-YYYYAll Year RoundTerm Time Only (over3s only)Sessions RequiredPlease tick/check in the grid below the sessions you require.Sessions Req: Under 3 All DayMondayTuesdayWednesdayThursdayFridaySessions Req: Over 3’s Full DayMondayTuesdayWednesdayThursdayFridaySessions Req: Over 3’s MorningsMondayTuesdayWednesdayThursdayFridaySessions Req: Over 3’s AfternoonsMondayTuesdayWednesdayThursdayFridaySessions Req: Over 3’s School DayMondayTuesdayWednesdayThursdayFridayBasic DetailsChild's full name *Known as *Date of birth or due date *dd-mm-YYYYStaff only:Confirmed birth certificate checkGender *Parent 1Basic DetailsName of parent 1 *Mr/Mrs/Miss/Ms/other *Do you have parental responsibility for this child? *YesNoDo you have legal contact? *YesNoAddress *Does the child live at this address?YesNoHome telephone no. *Mobile no. *Accept SMS?YesNoWork no. *Occupation *Email *Parent 2Basic DetailsName of parent 2 *Mr/Mrs/Miss/Ms/other *Do you have parental responsibility for this child? *YesNoDo you have legal contact? *YesNoAddress *Does the child live at this address?YesNoHome telephone no. *Mobile no. *Accept SMS?YesNoWork no. *Occupation *Email *Email ConsentBasic DetailsEmail address consent - Please sign to consent to us contacting you for the purpose of invoices, newsletters and information via Email (this is how we communicate with all parents)Start signing your signature hereYour browser does not support e-Signature field.Parent(s) with whom the child DOES NOT liveBasic DetailsName of parent(s) with whom the child DOES NOT liveDoes this parent have parental responsibility?YesNoDoes this parent have legal contact?YesNoDoes this parent have legal access to the child?YesNoAddress *Home telephone no.Mobile no.Security DetailsSecure PasswordA password system operates in our setting. A secure password is required and should be used by persons authorised to collect your child. Ideally this should be one word and something that is easily memorable.Please do not use obvious things such as middle names. The password is required from anyone collecting your child. If they do not have the password we will not release your child to them.My secure password is *Persons authorised to collect the childSecurity DetailsThis is any other adult who may collect your child in your absence. Authorised persons must be over 18 years of age.Authorised Person 1Security Details - Authorised PersonsName of authorised person 1 *Home telephone no. *Mobile telephone no. *Relationship to the child *Authorised Person 2Security Details - Authorised PersonsName of authorised person 2 *Home telephone no. *Mobile telephone no. *Relationship to the child *Additional Security InformationSecurity DetailsWe have the safety and well-being of the children in mind at all times and we are sure that you will appreciate that persons known to you are strangers to us and we do need means of identifying those you have authorised to collect your child (either authorised or emergency contacts) when you are unable to. We as a setting and especially your child/children’s key person will be familiar with you but we do not always have the opportunity to meet both parents. This is also true of your nominated emergency contacts and authorised persons. We therefore request that should anyone unknown to us collecting your child that you inform us in advance and show us a photograph to enable us to identify them when they collect your child.Health InformationDoes your child suffer from any of the following? (please select those which apply.)AsthmaHeart ConditionDiabetesSight ImpairmentWears GlassesEpilepsyKidney/Bladder ProblemsBee Sting AllergyDeafnessOtherIf you have selected any of the boxes above please give details hereDoes your child require medication, either long term for existing conditions or lifesaving drugs such as Ventolin?YesNoPlease give details of the medication and dosagePlease give details of the medication and dosage belowDoes your child have any special dietary needs or preferences?YesNoPlease select as appropriate and give details.Please give details of any special dietary needs below.Does your child have any known allergies?YesNoPlease select as appropriate and give details.Please give details of any known allergies below.GP InformationHealth InformationName of GP *SurgeryAddress *Telephone no. *Safeguarding ChildrenDoes your family have a social worker for any reason? *YesNoPlease state Yes or No.Name of Social WorkerTelephone No.Based atWhat is the reason for the involvement of Social Services with your family?FOR OFFICE USEFOR OFFICE USE - NB if the child has a child protection plan, make a note here, but do not include details. Ensure these are obtained from the social worker named above and keep these securely in the child's named Child Protection File.Optional Health InformationThe following information is voluntary and you do not have to complete it. However, we have a legitimate interest in requesting this data as it will assist in providing the necessary care for your child and to allow us to monitor and assess their development.Health VisitorHeath Visitor NameTelephoneLocation Based AtHas your child had their two-year check?YesNoIf so, on what date was this completed? *Are you able to share this information with the setting?YesNoOptional Health InformationThe following section requires information classed as ‘sensitive personal data’ for which we need your consent to collect and process. We request this data as, in some cases we have a contractual obligation to do so with your Local Authority, but also as we have a legitimate interest to allow us to plan and meet your child’s needs.Ethnicity and Cultural BackgroundHow would you describe your child’s ethnicity/cultural background?What is the main religion of your family?Are there any festivals or special occasions celebrated in your culture that your child will be taking part in that you would like to see acknowledged and celebrated while s/he is in our setting?What is/are the main language(s) spoken at home?If English is an additional language, will this be your child’s first experience of being in an English-speaking environment?YesNoSpecial Educational Needs and DisabilitiesDoes your child have any special needs or disabilities? *YesNoIf yes please give details below *What (if any) special support will your child require in our setting? *Professionals involved with the childProfessionals involved with the child - 1stName *Agency *Role *Telephone no *Professionals involved with the child - 2ndNameAgencyRoleTelephone noInformation for which we need your consent.The following section contains information for which we need your consent. As required by data protection we have a duty to inform you that you can withdraw your consent for any of the permissions detailed below at any time. Should you wish to withdraw consent please discuss this with a member of staff in the first instance.Permissions and ConsentPermission for the setting to act in loco parentisEmergency TreatmentIf emergency treatment is required, either whilst your child is on the premises or on an outing, (for the duration of your child’s time with us) and the parents or legal guardians cannot be reached immediately, your signature in the space provided below empowers the settings management to exercise their own judgement in calling the doctor/dentist indicated above or to transport the child to a hospital casualty department by ambulance. Please read and fill in the declaration below, cross out the statement/wording that does not apply, and sign and date this section.ConsentI/We Parent(s)/guardian(s) of *Permission? *DoDo Notgive consent for staff to apply high factor sun cream from our own supply if a bottle has not been provided by yourself.Signature of Parent 1 *Your browser does not support e-Signature field.Date Parent 1 signed *Signature of Parent 2Your browser does not support e-Signature field.Date Parent 2 signedPermission for the application of Sun CreamPlease read the statements below and select the statement that does applyField GroupI/We parents(s)/guardian(s) ofConsent *give consent for staff to apply high factor sun cream from our own supply if a bottle has not been provided by yourself.ORI/We parents(s)/guardian(s) ofConsent *give consent to allow staff to apply your own supply of sun cream, clearly labelled with my child’s nameSignature of Parent 1 *Your browser does not support e-Signature field.Date Parent 1 signed *Signature of Parent 2Your browser does not support e-Signature field.Date Parent 2 signedPlease tick the statements below if you consent to the following:I consent to my child participating in off-site outings as part of the daily practice e.g. trips to the park, shops, etc.I consent to my child having their photograph taken for use in displays, for name pegs, photo boards etc. within the settingI consent to my child having their photograph / video taken to be used for our public social media platforms- e.g Instagram, Website, Blog, Youtube, FacebookI consent to my child’s photograph /video being used on our private social media platform e.g. private parents Facebook groupI consent to my child’s artwork (with their name) being displayed in the settingI consent to my child’s photograph and video being used in learning journeys of other children with the settingI consent to my child being videoed for use by the setting staff only with regards to observational purposes, either assessment of children, an activity or for monitoring children’s behaviourI consent to information being shared with other professionals visiting the group such as Early Years Advisors, SENCO, Health Visitor etc. if necessaryI consent to my child’s learning journey being shared with Ofsted inspectors and/or as part of audits by the local authorityI consent to my child having sudocreme/barrier cream applied during nappy changesI consent to my child having face paint appliedI give consent for my child to have un prescribed calpol if they have a temperature of 37.5 or aboveI give consent for my child to have un prescribed Ibuprofen if they have a temperature of 37.5 or aboveI give consent for my child to have a plaster applied if neededI have read and understood that there is CCTV in operation throughout the settingFurther information regarding how we use children’s images within the setting can be found in our image Use Policy.SPECIAL NOTE: Please notify us immediately of any changes to the information provided. Please feel free to come and discuss any problems or concerns with us. If there are any other notes you would like to add, please use the space below.Please sign below to confirm the information in this document is correct.Signature of Parent/Guardian 1: *Start signing your signature hereYour browser does not support e-Signature field.Signature of Parent/Guardian 2:Start signing your signature hereYour browser does not support e-Signature field.FEE SUMMARY Monday Tuesday Wednesday Thursday Friday Monthly Fee Under 3 All Day Over 3’s Full Day Over 3’s AM Over 3’s PM Over 3’s School Day Sibling Discount 10% (Applied to Older Child) Other Fees TOTAL DUE MONTHLY/VARIABLE For Under 3’s we now require all children funding to be ‘stretched’ over a 12-month period. This option also remains in place for Over 3’s. In all cases stretching will commence from the first September a child is registered. In phasing the Local Authority grant over a 12-month period, any fees outstanding when a child leaves will be reconciled in a final statement of accountThere is a 10% sibling discount allocated to the Older sibling. * Under 3’s Note: A limited number of 2 year old funded only places are available for parents who qualify for 15 hours per week and have an early years voucher code (no extras). Please ask for more details. ** Over 3’s Note: Term Time Places available subject to availability INSPIRATIONS NURSERIES AND FOREST SCHOOL DAY NURSERY TERMS & CONDITIONS OF TRADE REGISTRATION A non-refundable administration fee of £100.00 is to be paid in advance to Inspirations Nursery and Forest School Ltd (“The Nursery”) by the parent/guardian (“The Parent”) on submission of the completed registration form and that fee shall not be returnable if acceptance is later withdrawn by the parent/guardian. The administration fee will be returned if the nursery cannot offer the place on the schedule and date required. PAYMENT OF NURSERY FEES Payment of nursery fees for the child’s attendance The Nursery shall be made by The Parent monthly, in advance, on the 5th of each month (the due day) by standing order only. This fee is detailed in the Registration Form plus any additional hours booked. The Parent is responsible for all Fees due, including those arranged via a contract with Leeds City Council or any other 3rd Party. Should the parent cease to be entitled to a payment via a 3rd party, then the parent is responsible for full fee. If payment of fees referred to in (i) above shall be outstanding for more than 7 days then the nursery may serve 7 days’ notice in writing to terminate this contract. Upon termination of this contract the child shall cease forthwith to be admitted to the nursery. All outstanding fees after the due date, a standard £15 late fee will be applied At Inspirations we pride ourselves in the qualifications, commitment and capabilities of our staff. To recruit the best people our fees are reviewed annually in April with reference to changes in the National Living Wage and Consumer Prices Index. The Nursery may increase fees giving one calendar months’ notice via e mail or via post to The Parent. Bills for late payment will be sent out, any disputes of bills should be put in writing within 14 days The nursery reserves the right to charge £10 for every 10 minutes a parent/guardian is late to collect their child. Opening hours are detailed in the Nursery Fees List. CALCULATION OF FEES For Current Fees refer to the Nursery Fee List. If nursery is unable to open due to adverse weather conditions or any other reason, full fees will be payable. The nursery provides all year around provision and closes for one working week at Christmas. The Nursery is also closed for bank holidays plus a maximum of three training days per year. Full fees are due on these days. The Nursery is compliant with the requirements of Leeds City Council Agreement for Providers of Free Early Years Entitlement which states (Clause 1.5): “This agreement does not provide guidance on how providers operate their private businesses, including charges for provision over and above a child’s free hours.” Fees are made up of a standard day rate plus additional extra services. See Nursery Fee List and Admissions Policy. Additional charges may be made for additional hours or services. The nursery does not permit the pro-rata reduction of payment of fees if the child is absent from nursery due to illness or holidays whilst the nursery is open. The parent/guardian is therefore obliged to make full payment. CANCELLATION/TERMINATION Either party may terminate this agreement by the service of one calendar months’ notice in writing. In the event of The Parent giving notice of withdrawal of the child and immediately withdrawing the child, fees are due whether or not the child attends nursery for the notice period. Notice must be in writing. If in the reasonable opinion of the nursery manager or person of similar standing or authority it is considered that the continued presence of the child referred to herein is detrimental to the health, safety or wellbeing of the child or other children of then The Nursery may serve notice to the parent/guardian or a request for the child to be excluded with immediate effect. No fees are due for the period the child is excluded. NON-SOLICITATION OF STAFF The Parent agrees that during the term of this agreement and for the period of 3 months following its termination howsoever terminated that he/she will not seek to employ, entice away or attempt to entice away from the employment of The Nursery any person or persons employed by the company at the date of termination of the agreement. COMPLAINTS Any complaints should be made in writing to The Directors, Inspirations Nurseries Ltd. VARIATION There shall be no variation of the agreement unless it is in writing made between The Nursery Manager and The Parent. In the event of a breach of contract and the Nursery fails to accommodate your child, any damages are limited to the standard daily fee. The employees of the company at the said nursery are not authorised to bind the company in respect of the following matter: The entering into of agreements be they oral or written with The Parent as to payment schedules of current fees or arrears of fees. The acceptance of any offer of fees other than in accordance with the Registration Form. Inspirations Nurseries and Forest School Ltd April 2024FOR OFFICE USE - Thank you for completing this form. You are welcome to see the information we hold on you and your child at any time. I/We confirm that the information provided on this form is correct to the best of our knowledge. I/We agree to the Terms & Conditions and Admissions Policy (separately attached) and pay the Fee Summary as detailed above and to drop-off and collect the child in line with the opening hours specified. Signature of Parent(s)/Carer(s)Your browser does not support e-Signature field.For Inspirations Nursery LtdYour browser does not support e-Signature field.DateThe term after your child’s third birthday, the monthly fee due for OVER 3’s due is calculated by taking the number of attendances in a calendar month. Note all payment is due for all bank holidays and training days. There is 1 week in the funding period, during term time, that is non funded. For any children eligible for the FEEE under 3 years old, the monthly fee due is calculated by taking the number of attendances in a calendar month. We accept all government funding in the usage of stretching it over the 51 weeks we are open -Submit Registration FormSave as Draft