Registration form

If you experience problems printing this page please forward your name and address to the Webmaster who will send you a hard copy in the post.

Please may we have the following information for our records:

Child’s full name………………………………………………………………………. Sex M/F

Address……………………………………………………………………………….……………

………………………………………………………………………………………….…………...

Post code…………………………………………Telephone………..…………………………

Date of birth……………………Religion……………………Ethnic Origin………….………..

Any cultural requirements…………………………………………………………………….....

In the event of an emergency please give the name of a neighbour/friend that we could contact:

Name………………..………………………………….Telephone………………………….…..

Name of Doctor………………………………………...Telephone……..……………………...

IMPORTANT

Has your child had his/her tetanus immunisation? Yes/No

Does your child suffer from any allergy or disability?Yes/No

If yes, please give details…………………………………………………..……………………

Parents full name..…………………………………………………...Title……………………..

Signature……..…………………………….. Date…….………………………….....................

PLEASE PRINT, COMPLETE AND RETURN THIS FORM WITH £10.00 REGISTRATION FEE TO:

St. Gabriel Playgroup

C/O 8 Downsview Cottages, West Street, Billingshurst. West Sussex RH14 9LH

Cheques made payable to St Gabriel’s Playgroup.

Please note: Your child will not be registered until this form is completed and received by us.