CHILD RECORD FORM

Child's Details—————————————---------------------------------------———--————

*Child's Name:
*Date of Birth:

Parent's Details—————————---------------------------------------———————————

*Mother's Name:
*Mother's Email:
Mother's Work No:
Mother's Mobile No:
Father's Name:
Father's Email:
Father's Work No:
Father's Mobile No:
*Home Tel No:
*Home Address:
*Unique Password:
Parental Restrictions:

School Details—————————--------------------------------------————————————

*Child's School:
*Head Teacher:
*Form Teacher:
*School Tel No:

Doctor's Details——----------------------------------------—————-————————————

*Doctor's Name:
*Surgery Name:
*Tel No:

Emergency Contact's Details———----------------------------------------------————-————

Example: Grandparents, Auntie/Uncle, Neighbour?
*Contact: (1)
*Home Tel No:
Mobile Tel No:
*Relationship to Child:
*Contact: (2)
*Home Tel No:
Mobile Tel No:
*Relationship to Child:

Medical History————-----------------------------------------———-————————————

Has your child been fully immunised against:

*Diphtheria
*Whooping Cough
*Tetanus
*Polio
*Measles
*Mumps
*Rubella
*Hib Meningitis
*Has your child had Chickenpox:

Important Information———--------------------------------------------————————————

Does your child have any:

*Allergies:
*Special Diet:
*Health Problems:
*Childhood Illnesses:
*Medical Conditions:
Any other important information:
If the answer to any of the above was yes, please give details:
Please state religion if applicable:

Please disclose any other information about your child that may be useful for us to know:

Submit Information———-------------------------------------------——————————-———

    

 

     

 

Operating Address: Village End, All Saint's Church Hall, London Road, Ascot, Berkshire. SL5 8DQ, Tel: 01344 623668, Mobile: 07778 555042.
Office Address: Brickfield Cottage, Swinley Road, Ascot, Berkshire, SL5 8AZ.
Tel: 01344 623668, Mobile: 07836 540433. Ofsted Registration Number: EY383966
After School Childcare Providers for Ascot, Sunninghill, Sunningdale, Cheapside & Winkfield Schools, Including: Ascot Heath, SAVS, St Michael's, St Francis,
Cranbourne, Harmans Water, Charters, Winkfield St Marys, LVS, Lambrook Haileybury, Local Pre-SchoolsUseful Links
Ascot Matters