Registration Once you have completed and submitted the form, we will be in touch. "*" indicates required fields Step 1 of 7 14% Child DetailsChild Name* First Last Child Date of Birth* DD slash MM slash YYYY Child place of birth* City/Town AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Child First Language*--select--EnglishArabicUrduPolishRomanianHindiGujaratiSpanishFrenchTamilChineseOtherWhat is your lagnuage?*Ethnicity*--select--BangladeshiIndianAny Oth Asian 'groundPakistaniBlack AfricanBlack CaribbeanAny Oth Black 'groundChineseAny Oth Mixed b'groundWhite and AsianWhite and Black AfricanWhite & Black CaribbeanInfo not yet obtainedAny other Ethnic GroupRefusedWhite BritishWhite IrishTraveller - Irish HeritWhite Northern IrishTraveller - Irish HeritAny Oth White b'groundGypsy/RomaOtherChild Gender*-- select --FemaleMaleHas you child attended another nursery?* Yes No Enter name of nursery* Child Details Name of parents/carers living at the above address, relationship to child (i.e. mother, father, stepmother etc) Who have legal parental responsibilities for this child (PR) and are living at the same address.Parent Name* First Last Date* DD slash MM slash YYYY Parent National Insurance Number*Parent Email* Parent Phone Number*Parental Responsibility*YesNoRelationship to Child*--select--MotherFatherOtherPlease specify your relationship to Child*Would you like to add another Parent/Carer? Yes No Parent Name /2* First Last Parent Date of Birth /2* DD slash MM slash YYYY Parent National Insurance Number /2*Parent Email /2* Parent Phone Number /2*Relationship to Child /2*--select--MotherFatherOtherPlease specify your relationship to Child /2* Address Parent/Carer Address, Who have legal parental responsibilities for this child (PR) and are living at the same address.Address* Street Address City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Childcare RequirementsPlease tick all that apply: I need childcare term time only I need childcare all year round I am entitled to two years free funding I have a 30 hours code Please type the 30 hours codeAny Specific Requirements Yes No Specific Requirements*Please select your preferred days* Monday Tuesday Wednesday Thursday Friday Please select your preferred time*--select--All DayMorningAfternoon Family DetailsDoes your child have any other siblings* Yes No Sibling Name First Last Sibling Date of Birth DD slash MM slash YYYY School AttendingDoctor/ GP DetailsGP Surgery NameGP Surgery TelGP Surgery AddressHealth Visitor NameHealth Visitor TelHealth Visitor AddressDentist NameDentist TelDentist AddressEmergency ContactsEmergency Contact Name* First Last Emergency Phone Number*Relationship*--select--FatherMotherOtherSpecify the relation*Do you want to add another Emergency Contact?* Yes No Emergency Contact Name /2* First Last Emergency Phone Number/2*Relationship /2*--select--FatherMotherOtherSpecify the relation /2* PermissionsShould there ever be the need to seek medical advice and/or treatment/ minor first aid or we need to call an ambulance for emergency we need written authority from you to act on your behalf if we are unable to contact you.* Yes No Our statutory responsibilities require us to share information with multi agencies for example (safeguarding concern, health visitor, family worker) Do you give permission?* Yes No Can we take your child on local walks?* Yes No I give permission for my child’s photograph to be used at the nursery for name tags, displays etc* Yes No I give permission for my child’s photograph to be used for the nursery website, social media and other marketing materials* Yes No We may require passing on information or documents about your child to the next setting/school, for this we require your permission I give permission for my child’s photograph to be used for the nursery website, social media and other marketing materials* Yes No I give permission for my child to touch animals/insects at nursery* Yes No I give permission for my child to participate in Face painting/ Henna activities* Yes No I give permission for my child to participate in large play climbing apparatus* Yes No I give permission for my child to take part in risky play opportunities ensuring appropriate supervision is provided* Yes No DeclarationUntitled* I give permission for all staff at Kinder City to take actions to all the statements mentioned above. I will not hold the nursery responsible for the implementation of the above.