Harmony Neighbourhood Nursery | Apply for a Place

Step 1 of 6 - Child Info

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Child's Name
First Last
Known As
D.O.B*

DD
MM
YYYY
Gender*
- Boy
- Girl
Address*
Street Address Address Line 2 City Postal Code Country
Home Number (Incl. area code)*
Mobile Number*

Parent Name 1*
First Last
Email*
Work Address*
Street Address Address Line 2 City Postal Code Country
Work Number*
For emergency use
Parent Name 2
First Last
Work Address
Street Address Address Line 2 City Postal Code Country
Work Number
For emergency use
Language(s) Spoken or Understood
Ethnic Background

Who will usually collect your child from nursery?
If different from the Parent info provided
Address
Street Address Address Line 2 City Postal Code Country
Phone Number
(Incl. area code)
Mobile Number
(Incl. area code)
People authorised to collect my child*
Please state their full name and contact phone number. Type in N/A if not applicable

Emergency Contact Name*
First Last
It is essential that a name other than parents is given for use
Address*
Street Address Address Line 2 City Postal Code Country
Daytime Home Number*
(Incl. Area Code)
Mobile Number*
Relationship to Child*

Dietary Considerations/Special Diet?
Health Considerations
Medical Conditions
Other Helpful Information - Glasses, Hearing, Speech

GP/Surgery Name*
Address*
Street Address Address Line 2 City Postal Code Country
Phone Number*
(Incl. Area Code)
Record of previous immunisations & infectious diseases*
Other Special Requirements
Details of any restrictions prohibited for Medical / Religious or other reason