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Registration Form
Please note that completion of the registration process does not guarantee your child a place. Once submitted the nursery office will contact you directly to confirm receipt and arrange next steps.
Name
This field is for validation purposes and should be left unchanged.
Child Information
Name of child
*
First
Last
Sex
*
Boy
Girl
Date of birth
*
Does your child have siblings?
*
Yes
No
Name(s) of Sibling(s)
*
First Name
Date of birth
Does your child have any medical conditions?
*
Yes
No
Details of any known learning difficulties or medical conditions
*
Medical Condition
Does your child speak any other language at home other than English?
*
Yes
No
What language?
*
Contact Details
Name Parent 1
*
Title
Mr
Mrs
Miss
Ms
Dr
Prof.
Rev.
Title
First Name
Last Name
Mobile Phone Parent 1
*
Email address Parent 1
*
Enter Email
Confirm Email
Occupation Parent 1
*
Name Parent 2
*
Title
Mr
Mrs
Miss
Ms
Dr
Prof.
Rev.
Title
First Name
Last Name
Mobile Phone Parent 2
*
Email address Parent 2
*
Enter Email
Confirm Email
Occupation Parent 2
*
Main Home Address (for correspondence)
*
Street Address
Address Line 2
Postcode
Home Telephone Number
Funding Information
Please refer to the government's funding website
Best Start in Life
to check your eligibility for Early Years funding support.
I anticipate that my child will be eligibile for the following funding beyond the 15 hours funding for all 3-4 year olds:
*
No funding beyond 15 hours universal entitlement
30 hours childcare for eligible families
Additional Information
Proposed Primary School
*
How did you hear about Bertrum House Nursery?
*
Live locally
From nursery parent
Online search
Online forum
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