Registration Form - Little Grange Nursery

Please complete this form in as much detail as possible. We need this information to be able to process your application for a place. Mandatory information is marked as required

Child's Details

Name(Required)

First names Surname of Child

Nationality(Required)

If a nationality other than British is declared please also include the documents cited in the blue section in the latter part of this form.

Religion

Date of Birth or Due Date(Required)

Required Start Date(Required)

e.g. Sept 2022

Gender

Type of Place(Required)

(Please select all which apply)

Curious Cubs Baby Room

Little Lions Toddler Room

Rangers (Pre-School)

Have you registered your child's name at any other Nursery and if so, which?

Parent / Legal Guardian Details

Legal Guardian 1

Name(Required)

Title (e.g. Mr, Mrs, Ms, Dr) First name Middle names Surname

Permanent address of Parent / Legal Guardian 1 including postcode(Required)

Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country

Telephone | Main Contact(Required)

Telephone | Mobile

E-mail(Required)

Occupation

Employer's Name

Employer's Address

Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country

Legal Guardian 2

Name

Title (e.g. Mr, Mrs, Ms, Dr) First name Middle names Surname

Permanent address of Parent / Legal Guardian 2 including postcode

Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country

Telephone | Main Contact

Telephone | Mobile

E-mail

Occupation

Employer's Name

Employer's Address

Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country

Are there other people with parental responsibility?

Yes

_{(Please provide the name(s) and current address(es) of any other person with parental responsibility (i.e. legal responsibility) for the above-named child. This may be a legal guardian or stepparents and their consent to the child attending the Nursery will be required if an offer of a place is made.}

Name

Title First Names Last Name

Address including postcode

Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country

General Questions

Please indicate how you first heard of the Nursery

Other, please specify?

Connections with the Nursery

(Please mention here the names of any other members of the family attended, registered for entry, or any other connected with the Rugby Schools Group.)

Please state the name and address of your present nursery if applicable (with dates of attendance).

Name of present nursery

Address of present nursery

Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country

Dates of attendance | From

Please confirm whether your child requires sponsorship to reside in the United Kingdom

(if applicable)

Yes

If you have answered yes to the above, please provide the valid immigration category that applies to your child.

Please provide full details below

If your child has or will have a time restricted or temporary visa in any other immigration category (for example, as a dependent) please provide a copy of this below. Please note that we will be unable to process your registration until such copy documentation is provided.

Please note, we reserve the right to:
a) request further information and sight of documentation in support of your declarations regarding immigration; and
b) to share information with UK Visas and Immigration (UKVI) and the Home Office for the purposes of compliance with our responsibilities as a licensed sponsor

Rugby Schools Group may be required to notify and / or supply information relating to your (o.e the parents) and / or your child's right to enter, reside and / or study in the United Kingdom to UKVI and the Home Office (and to do so whether we sponsor your child or not).

Upload your documentation

Drop files here or

Max. file size: 20 MB, Max. files: 5.

Confidential Information Form for Special Educational Needs, Learning Support, Medical Conditions and Disabilities

All information received in this form will be treated in confidence.

Child's full name(Required)

Name of parent / legal guardian (1)(Required)

Name of parent / legal guardian (2)

I/We are not aware of any health conditions, disabilities, special education needs or learning support needs that the school should be made aware of for our child

The statement above is true

Please disclose any medical condition, health problem or allergy affecting your child.

Has your child ever received a specialist assessment (e.g. GP Referral for Assessment) or any additional learning support in their current setting?(Required)

Yes

If yes, please specify?

If applicable to your child, it will also help us plan for their arrival, if you can let us know of any:

learning difficulty.
special educational need.
disability; or
behavioural, emotional, and / or social difficulty.

The information provided in this form will enable the Nursery to consider any adjustments that it may need to make to assist your child to partake in the Nursery’s admissions procedure or when s/he enters the Nursery.

Please provide us with as much detail as possible in the space below. Where possible, please provide any relevant documentation such as medical reports, assessments etc.

Prior to the commencement of the admissions process, we will contact you about any special arrangements your child may require.

The information requested on this form is needed because the Nursery has contractual and statutory duties towards your child.

It is your responsibility to let us know if any of the information you have provided changes prior to your child starting at Little Grange.

Sessions Required

Please indicate which sessions are required, we will try our best, but sessions offered with be dependent on availability.(Required)

Minimum Sessions: 6 per week

Please press control and select the sessions you require (cmd on Apple-Mac).

Declaration

Early registration is recommended. Registrations will be considered in the order they are received. Offers of places are subject to availability and the admission requirements of the Nursery at the time offers are made. A copy of the Nursery’s Terms and Conditions will be supplied on request.

I/We request that our child named above is registered to join Little Grange.
I/We have completed the Confidential Information Form

Signature(Required)

Legal Guardian 1

Name in Full(Required)

Date of Birth(Required)

Relationship to child(Required)

Date(Required)

I confirm that I am the only legal guardian of my child

I am the only legal guardian

Signature

Legal Guardian 2

Name in Full

Date of Birth

Relationship to child

Date

Payment Details

Cheque Details: Payable to ‘Little Grange Nursery Limited'

Addressed to: Admissions, Little Grange, Homefield Lane, Dunchurch, Rugby, Warwickshire, CV22 6QS

Electronic Payment

Account Name: Little Grange Nursery Limited
Sort Code: 54-41-00
Account Number: 50468081
Please use your child's full name as reference for payments.

Consent

I agree to the privacy policy.

For more information about how the Nursery will use your information, and your child’s information, please see our privacy notice here.

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