Registration - Tots and Co

CHILD REGISTRATION FORM

Please note that until all registration documents and completed form is logged with the playschool you have not registered your child for a place in Tots and Co Playschool.

Note to Parents/Guardians
Please ensure that you read this form carefully and answer all questions. We have a responsibility under the Child Care Act 1991 (Early Years Services) Regulations 2016 to collect specific information relating to your child. Also, the more information we can gather the better quality a service we can provide. Thank You!
BOOKING INFORMATION
START DATE - September 2023 LEAVING DATE – June 2024
DAYS PER WEEK – 5 Days (Monday to Friday)
HOURS PER DAY – 3 Hours per day

PLACE TYPE

SESSIONAL ECCE

Name of Child

Date of Birth

Address

Names of Other Children Attending the service

Parent/Guardian Name

Relationship to child

Address:

(Tel) Home:

(Tel) Work:

Mobile:

Email:

Parent/Guardian Name

Relationship to child

Address:

(Tel) Home:

(Tel) Work:

Mobile:

Email:

Who may be contacted in an emergency if parents are not available?

Name:

Address:

Work:

Mobile:

Family doctor

Name

Address

Contact number

Medical history (Please outline any illnesses your child may have)

NOTE Medical Care Plans may be required

Does your child have any allergies?

Yes No

If Yes, please complete the Form Below

What is the child allergic to?

What is the nature of the allergic reactions? e.g. anaphylactic shock reaction, including rash, reddening of skin, swelling, breathing problems etc.

What to do in case of allergic reactions, any medication used and how it is to be used? (e.g. Epipen).

Is Medication Used?

Control measures – such as how the child can be prevented from contact with the allergen.

Other Comments

PRESCRIBED MEDICATION
Parents must sign and complete a medication form before prescribed medication is administered. Prescribed medication must clearly state child's name, dosage, route of administration, date and expiry date. We can only accept medicine that has the original pharmacy label and is written in the English language.
AGREEMENT FOR MEDICAL TREATMENT

I hereby give/do not consent to my child (name of child)

receiving medical treatment if a doctor thinks it is required as an emergency and I cannot be contacted following reasonable attempts to do so prior to such treatment being administered.

Signed (please upload image for your signature)

Date

Witnessed (please upload image for your signature)

Date

AGREEMENT FOR ANTI FEBRILE MEDICATION
The service will only administer ‘Calpol’ (paracetamol) or Nurofen (Ibruprofen) if a child becomes unwell and has high temperature of 38°C or over. If a child has a high temperature the parent will be contacted before staff administer the temperature reducing medication and they will be asked to collect the child.
My child does/does not have an allergy to anti-febrile medication. (Delete as appropriate)

I hereby give consent/do not give consent to (name of child)

to receive anti-febrile medication, in the event of a high temperature.

Signed (please upload image for your signature)

Date

Witnessed (please upload image for your signature)

Date

IMMUNISATIONS

6 in 1 (All)

Yes No

Date

Pneumococcal Conjugate Vaccine (PCV

Yes No

Date

Meningococcal C (Men C)

Yes No

Date

Mumps / Measles / Rubella (MMR)

Yes No

Date

Haemophilus Influenzae B (HIB)

Yes No

Date

Oral Polio

Yes No

Date

Meningitis C

Yes No

Date

We ask Parents to supply a copy of all vaccinations the child has received

Copy of vaccination record attached?

Yes No

I confirm that my child has been vaccinated on dates as above

Signed Parent (please upload image for your signature)

Date

I confirm that my child has been vaccinated but cannot access details of dates

Signed Parent (please upload image for your signature)

Date

Does your child have any additional special needs? Note: You may be required to complete separate care plans in respect of your child relating to their additional/special need.

If your child is not vaccinated, we require you to sign a disclaimer form

SUN POLICY
We ask parent(s)/Guardians to leave a ‘sunny day bag’ with sun hats, sun glasses etc. in our service. All children will be required to wear a hat when playing outside in the sun. The service will encourage all children to wear clothes that provide good sun protection e.g. sun hats, sunglasses. The service will also encourage children to cover very exposed areas of the skin, such as shoulders. We ask parent(s)/Guardians to bring in a labelled bottle of unopened sun-cream of at least 40 SPF. Staff will apply the sun-cream to children before they go outdoors.

I give permission for sun-cream to be applied to my child

from the labeled sun cream supplied. The sun cream will be applied in the correct way all over the body and in the correct amount. I will bring in an unopened and labelled bottle of sun-cream of at least 40 SPF.

Signed (please upload image for your signature)

Date

Witnessed (please upload image for your signature)

Date

I give permission for my child

To go on local outings

Yes No N/A

To have their photo taken (by tablet, app, camera, phone)

Yes No N/A

To be recorded on video

Yes No N/A

To have their photo uploaded to Facebook or other social media (if applicable)

Yes No

To have their photo uploaded to our website (if applicable)

Yes No

To be observed by our professional staff and developmental checks to be carried out

Yes No

To eat birthday treats sent in from other parents (if applicable)

Yes No

To access the internet under supervision

Yes No

To display photographs within the setting (including group photographs)

Yes No

You may be asked to sign for other specific permission relevant to the service.

Signed (please upload image for your signature)

Date

Witnessed (please upload image for your signature)

Date

CHILD PROTECTION
We have a moral and legal obligation to ensure that all children in our care are protected, and their health and welfare are safeguarded.
Our staff are mandated to report any concerns
All staff in the service are vetted through the Garda vetting unit and have the correct qualifications to work with children. We act to protect children from harm, which may arise. It is our duty in this case to question the cause of any behaviour, bumps, bruises or unusual markings. Our main concern in the service is to safeguard and protect the welfare of children. We have a responsibility to identify report and record any suspicions of child abuse to Tusla the Child and family Agency. We have a responsibility to respond to all child protection concerns.

COLLECTION AUTHORISATION

I authorise the following people to collect my child

in the event of my absence. I acknowledge unless I have spoken to the Manager my child cannot be collected by any other person.

Name

(Tel) Home

Mobile

Address

Relationship to child

Name

(Tel) Home

Mobile

Address

Relationship to child

Name

(Tel) Home

Mobile

Address

Relationship to child

I confirm that the above persons have been informed by me that their details have been shared with the service

Signed (please upload image for your signature)

Date

Separated and Divorced Parents
Married parents are automatically joint guardians of their children. Neither separation nor divorce changes this.
By law, an unmarried mother is the automatic guardian of a child born outside of marriage. In some circumstances, unmarried fathers have automatic access. The service should be informed about access rights. Unmarried fathers will automatically become guardians of their children if they meet a cohabitation requirement. An unmarried father who cohabits for 12 months with the child's mother, including 3 months following a child's birth, will automatically become the child's guardian. This provision is not retrospective, so guardianship will only be acquired automatically where the parents live together for at least 12 months (applies to children born after 18 January 2016.)
- We cannot refuse either parent to collect their child unless a court order is in place.
- We ask that parents give us information on any person that does not have legal access to the child.
- Where custody of a child is granted to one parent, we would ask you to clarify the circumstances with us. This information will remain confidential and will only be made known to the relevant staff. If there is any legal documents i.e. custody order, barring order we would ask you to provide us with a copy to keep on file.

ALL ABOUT ME (THIS IS OPTIONAL)
We believe it is important to know as much as we can about a child before they start our service. Completion of the following section of this registration form is optional for parents and guardians, but we believe it helps us to get to know the child and helps settle a child into the service if we know things about them.

Does your child have any brothers or sisters?

What are the names of other family members and other significant people close to the child?

Do you have any pets?

What languages are spoken at home?

What is your child’s favourite food?

Has your child any previous experience of early childhood services/toy library/parent and toddler groups?

Does your child have any particular play interests at the moment, or particular toys he/she likes to play with?

What other things does your child show interest in or talk about?

Does your child enjoy and get involved in imaginative type play and/or activities such as drawing, painting, puzzles, and building?

Does your child enjoy books and listening to stories? Does he/she have any favourite rhymes, stories, videos or CD’s?

How do you comfort your child when he/she is upset? Does he/she need any comfort toys?

Do you have any concerns or worries about your child’s development?

Is there any other information you would like us to know?

Religion

Food: special diet, restricted foods

Your Childs PPS Number

Your Childs Vaccine Record Book

Your Childs Birth Certificate

Other files you want to attatch

Data Privacy - Consent for Collection and Usage of your personal data
I have read the Service’s Privacy Notice, and I understand the reasons for requesting the personal information sought about myself and my child in this Registration form.
I consent to the collection and processing of the data given, for these purposes, by Tots and Co
I understand that I can request a copy of this information, and revise or withdraw my consent by contacting the service at any time.

Parent or Guardian’s signature (1) (please upload image for your signature)

Parent or Guardian’s signature (2) (please upload image for your signature)

Manager/designated person’s signature (please upload image for your signature)

Date

CHILD REGISTRATION FORM

CONTACT INFO

4, New line Close, Mountrath, Co. Laois R32 E523

colette@totsandcoplayschool.ie

087 416 2377

Office Hours

CONTACT INFO

Office Hours