Shining Stars Nursery Induction Form

  • Please complete the information below for children aged 2-4yrs

    This form needs to be completed in order to secure your child's place

  • / /
    Pick a dates.
     
  • If no, please complete the section below.

  • Medical Information & Dietary Needs

  • Medical Notes : Does your child have any known problems with the following? If yes, please give details *
      Yes No
    Hearing
    Vision
    Speech
    Does your child wear glasses?
    Is your child allergic to plasters?
    Does your child have a food allergy?
    Does your child require any long term medication?
  • Does your child have any medical conditions which could affect him / her? If yes, please provide details below *
      Yes No
    Diabetes
    Serious Heart Condition
    Epilepsy
    Asthma
  • Please detail your child's immunisations to date: *
      Yes No
    Triple (Diphtheria, Tetanus, Whooping Cough)
    As above without Whooping Cough
    Polio
    Measles/Mumps/Rubella
    Meningitis C
  • Ethnic/Cultural Information

    This information will be used to compile statistics which will be passed to the Local Education Authority and the DFE to contribute to local and national statistics. The information will not be used for any other purpose and will not allow individual children to be identified publicly. When your child leaves, this information will be passed on to the new school. You can ask to check your child’s information at any time and let us know if it is incorrect.

  • Please select from the below *
      Yes No
    Is English your childs additional language?
    Do you speak Welsh?
    Are you an Asylum Seeker
    Are you a Refugee?
  • Emergency Contacts (alternative to Parents details)

    Please ensure that emergency contacts are in reasonable distance to the provision and based in the UK, as they may well be contacted to collect an unwell child if we are unable to contact the parents. We will always try to contact Parents / Guardians first from the details above followed by contacts listed below.

  • If you have a Nanny /Childminder who will be collecting your child, please complete section below.

  • Child Welfare

  • / /
    Pick a dates.
     
  • Additional Information

  • Please state name and address of provider including start and finish dates

  • Home Agreements

    Please download and review a copy of each of the agreement files (linked below)

  • KidsQuest Home Agreement

    Shining Stars and Rockets Home Agreement

  • Clear

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