Pupil Information Form

In order for us to maintain up to date records please complete the form below before your child starts at Duchal.

Child's Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Child's Date of Birth

YYYY

Mother's Name

First Name

Last Name

Mother's Mobile

(###)

###

####

Father's Name

First Name

Last Name

Father's Mobile

(###)

###

####

Name of Emergency Contact

First Name

Last Name

Emergency Contact Mobile

(###)

###

####

GP Surgery Phone Number

(###)

###

####

Please state any allergies and dietary requirements:

Additional Information: Is there anything relating to family/ health issues you would like the staff to be aware of in confidence. (Please write below or speak directly to Mrs Gheur)

Consent Form

Please complete the following:

Child's Name

First Name

Last Name

Urgent Medical Consent

I hereby confirm that if the above mentioned child requires urgent medical treatment and I or other people given to you as contact names cannot be contacted on the contact numbers supplied to you then the teaching staff of the school are authorised to give the necessary First Aid and also to authorise a medically qualified person to give whatever treatment is necessary.

I consent

Photographic Consent

I hereby give permission for Duchal Nursery to use photo images for purposes on the nursery website, social media content and for marketing purposes

I consent

Transport Consent

I hereby confirm that if the above named child requires to be transported at any time whilst taking part in the activities of the nursery school the teaching staff of the nursery are authorised to organise transport.

I consent

Parent Name:

First Name

Last Name

Getting to know your child

To help your child settle at Duchal please complete the following information so we can get to know more about your child:

Child's Name

First Name

Last Name

Also known as - Name

First Name

Last Name

Who lives in my house?

My favourite toy / game is:

I really like:

I dislike:

My pets are:

My friend is:

Any other relevant information that you feel will be helpful:

Parent’s Comments

Child's Name

First Name

Last Name

Please indicate stage of toileting:

All children should be toilet trained before they start at Duchal

Speech:

Please give us an indication of standard of speech of your child:

Previous nursery/playgroup experience:

Any other comments that you feel may help with settling your child: