Fully qualified staff care for the children at Seren Fach, with an aim to develop the child's personal and social skills alongside language, literacy, communication and physical development.

To complete our Registration Form please click here.

DECLARATION OF INTEREST

Please click on the following link to view our Printable Declaration of Interest Form.

You will require Adobe Acrobat to view the file. If you do not have a copy of this software please click here to download your FREE version.

Please send the form to:

Eleri Jones, Manager
Seren Fach Nursery, Brithdir, Dolgellau, Gwynedd LL40 2RP.

Name of child:

Date of birth:

Gender:

Home Address:

Phone No:

Parent's names:

Other Phone Numbers

Mother at work:

Father at work:

Doctor's name and address:

Doctor's Phone No:

Person to contact in emergency:

Phone No:

Name of person collecting the child from nursery familiar to the staff or carrying proof of identity:

Child's position in the family (e.g. 3^rd with older brothers, elder with a younger sister, only child):

Other members of family and names:

Mother's language:

Father's language:

Family's language:

Religion:

Does the child have...

a special toy or comforter?

a special word for going to the toilet?

fears or hates?

HEALTH DETAILS

Vaccinations and dates:	Diphtheria, Whooping cough, Tetanus:	Date:
	Polio:	Date:
	MMR:	Date:
	Meningitis:	Date:
	date of last tetanus vaccination:

special needs e.g. diet:

other information about the child that the nursery should know about:

I GIVE PERMISSION FOR MY CHILD TO BE GIVEN ANY EMERGENCY MEDICAL TREATMENT WHICH MAY BE NECESSARY:

Name:		Date:
Email: