ADMISSION FORM October 2010
To be completed by the parents and given to the childminders prior to start date.
These records are made available to the Ofsted Inspection Officer only and otherwise remain confidential.
Name of Your Child:
Your Child's Date of Birth:
Your Home Telephone No:
Email Address:
Your Home Address:
Mother's Name:
Work or Study Address:
Contact Telephone No:
Mobile No:
Father's Name:
Work or Study Address:
Contact Telephone No:
Mobile No:
Who has parental responsibility for your child?
Named individuals who MAY collect your child?
Named individuals who may NOT collect your child?
(Please note that children under 14 may not be responsible for collecting children and that ideally the childminders should be introduced to anyone who you may want to collect your child. Childminders must always be advised if someone different will be collecting the child).
Is there a relative or friend who can be contacted in an emergency if the childminders is unable to contact you?
Name: Tel No:
Signed by Parents……………………………………………….. Date……………
Please give the name and telephone number of the following people:-
Doctor: Tel No:
Health Visitor: Tel No:
Social Worker: Tel No:
Medical Information
Does your child suffer from any known allergies?
Does your child require any special skin care?
Has your child had any serious illnesses?
Please complete the details of your child's immunisations with dates:
Age Immunisation Imm. Date
Routine
2 months Diphtheria, Whooping Cough, Tetanus,
Polio, HIb, Pneumococcal Infection
3 months Diphtheria, Whooping Cough,
Tetanus, Polio, HIb, Meningitis C
4 months Diphtheria, Whooping Cough, Tetanus, Polio,
HiB, Meningitis C, Pneumococcal Infection
12 months Hib, Meningitis C
13 months Measles, Mumps, Rubella,
Pneumococcal Infection
3 years 4 months Diphtheria, Whooping Cough, Tetanus,
Polio, Measles, Mumps, Rubella
Non-routine
At birth Tuberculosis
At birth Hepatitis B
Health Checks
Age Date Carried Out
6 weeks
7 months
18 months
3 years
Has your child any health problems that require medication or that the childminder needs to know about?
Diet
Does your child enjoy food?
Likes:
Dislikes:
Is your child on a special diet of any kind or are there any foods that your child must not eat?
What does your child usually eat for -
Breakfast:
Lunch:
Tea:
Drinks: Dried Milk? Cow’s Milk?
Water? Juice/Water? Other
Cup? Feeder? Bottle?
Nappy Changing
Do you have a preference for water/wipes/creams?
Toilet Training
If your child is toilet trained, how does s/he ask to go to the toilet (what name does s/he use for the toilet)?
If you are toilet training your child at the moment then you need to explain to the childminders how you are doing this so that you are both helping your child in the same way.
If you are planning to start training then it makes sense to wait until your child is settled with the childminders.
Sleeping
What time of day does your child sleep?
For how long?
Does your child have a toy, dummy or other comfort for sleeping?
How does your child usually let you know s/he is tired?
How does s/he like to be settled to sleep?
Cultural or Religious Observances
Are there any cultural or religious observances that you would like the childminder to take into account when looking after your child? (e.g. diet, dress, religious holidays or festivals).
Language
What languages are spoken at home?
Does your child have any special words it would be helpful for the childminders to know?
Social
Has your child had experience of mixing with other young children e.g. family, parent and toddler group, or other group or previous child carers?
What is your child's favourite toy/play activity/fictional character/book/song?
When your child is upset, what will help to calm her/him? (e.g. cuddle, stories, music, dummy).
Is your child fearful of anything like pets, loud noises, hoover, etc.?
Young children often talk about their relatives, friends, pets or favourite toys as these are very important to them. Who are the important people in your child's life? This will help the childminders to 'make sense' of the things your child shares with them and to encourage his/her language development.
Please supply photographs of close relatives/pets/special friends.
Is there anything else that you think the childminders should know about your child, or that will help her to settle and care for your child?
Do you currently have any problems with your child, e.g. biting/hitting other children?
How would you like the childminders to manage this behaviour? (Obviously in line with the Early Years Foundation Stage Statutory Requirements’ guidelines on behaviour management).
Wendy & Louis Bernardelle