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Home
About Us
Our Rooms
Small World Room
>
Small World Room - Parents
Junior Room
>
Junior Room - Parents
Pre-School Room
>
Pre-School Room - Parents
Garden
Registration
Contact Us
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YOUR CART
Wizkidz Nursery - Registration Form
**Please let us know if any of your details change**
*
Indicates required field
Child's Full Name
*
First
Last
Date of Birth
*
Address
*
Line 1
Line 2
City
State
Zip Code
Country
Parent/Guardians Name
*
First
Last
Relationship to the Child
*
Home Tel Number
*
Mobile Number
*
Email Address
*
Address (if different from above)
*
Line 1
Line 2
City
State
Zip Code
Country
Workplace
*
Work Tel Number
*
Work Address
*
Line 1
Line 2
City
State
Zip Code
Country
Parent/Guardians Name
*
First
Last
Relationship to the Child
*
Home Tel Number
*
Mobile Number
*
Email Address
*
Address (if different from above)
*
Line 1
Line 2
City
State
Zip Code
Country
Workplace
*
Work Tel Number
*
Work Address
*
Line 1
Line 2
City
State
Zip Code
Country
Emergency Contact 1 Name
*
First
Last
This will be used if we can't reach the numbers above.
Contact Number
*
Relationship to the Child
*
Address
*
Line 1
Line 2
City
State
Zip Code
Country
Emergency Contact 2 Name
*
First
Last
This will be used if we can't reach the numbers above.
Contact Number
*
Relationship to the Child
*
Address
*
Line 1
Line 2
City
State
Zip Code
Country
Doctors Name
*
First
Last
Surgery Address
*
Line 1
Line 2
City
State
Zip Code
Country
Health Visitors Name
*
First
Last
Contact Number
*
Social Worker Name (if applicable)
*
First
Last
[object Object]
Contact Number
*
Unique Password For Pick Up
*
Sessions - please tick attendance pattern below.
Monday
*
Morning
Afternoon
Tuesday
*
Morning
Afternoon
Wednesday
*
Morning
Afternoon
Thursday
*
Morning
Afternoon
Friday
*
Morning
Afternoon
Please select yes if your child is receiving early learning and childcare from Midlothian Council - If so please state funded hours.
Early learning childcare – A good time to be two
*
Yes
No
If yes, state funded hours
*
Early learning childcare – 3 – 5years
*
Yes
No
If yes, state funded hours
*
Proposed Starting Date
*
Who will collect your child each day?
*
If for any reason it will not be the named person above or there is a change in collection time, please inform staff as soon as possible. Please ensure that anyone picking up your child knows the unique password you have given us.
Our policy is that 4 weeks written notice is given, or 4 weeks fees be paid in lieu of notice when terminating your child's contract.
Fees are calculated over 52 weeks and should be paid in advance including closure over Christmas and New Year.
By clicking 'submit' at the end of this form you agree that you have read and agree to abide by the terms and conditions stated above.
Medical Details
Please tick if your child has had any of the following childhood diseases:
*
Chicken Pox
Measles
Mumps
Scarlet Fever
Whooping Cough
Not Applicable
Please indicate what immunisations your child has had and date:
1st Diphtheria/tetanus/Whooping cough/HIB/Polio/Meningitis C
*
Yes
No
Date Given (if applicable)
*
2nd Diphtheria/tetanus/Whooping cough/HIB/Polio/Meningitis C
*
Yes
No
Date Given (if applicable)
*
3rd Diphtheria/tetanus/Whooping cough/HIB/Polio/Meningitis C
*
Yes
No
Date Given (if applicable)
*
Measles, Mumps, Rubella (MMR)
*
Yes
No
Date Given (if applicable)
*
4th Diphtheria/tetanus/Whooping cough/HIB/Polio/Meningitis C
*
Yes
No
Date Given (if applicable)
*
For allergy purposes please confirm that your child has tried all of the foods on our menus at home prior to them starting?
*
Please state any known allergies, any foods you would prefer your child not to have or any religious requirements below:
*
Please state any additional information below:
*
By clicking 'submit' you confirm that the details above are correct to the best of your knowledge.
Submit
