Bijou Nursery

Printable Application Form

Please print this form, complete it, and return it to the nursery by handing it in to the office or to the nursery manager.

1. Personal details of child

Child's surname
Child's first names
Gender
Date of birth
Language spoken at home
Religion
Child home postcode
Collection password
Does the child live at a different address?
Special needs or disabilities
Child home address
All about me

2. Main contact details

Parent / main carer name
Email address
Phone number
Preferred contact method
Best time to call

3. First adult details

Relationship to child
Title
Surname
First name
Postcode
Email address
Home telephone
Mobile
Work telephone
Parental responsibility
Home address
Employer name and address

4. Second adult details

Relationship to child
Title
Surname
First name
Postcode
Email address
Home telephone
Mobile
Work telephone
Parental responsibility
Home address
Employer name and address

5. Emergency contact 1

Name
Relationship to child
Postcode
Telephone number
Mobile
Parental responsibility
Address

6. Emergency contact 2

Name
Relationship to child
Postcode
Telephone number
Mobile
Parental responsibility
Address

7. Sessions and attendance

Using Childcare Offer for Wales
Attendance type requested
Requested start date
Estimated finish date
Actual finish date
Monday timing
Tuesday timing
Wednesday timing
Thursday timing
Friday timing
Requested schedule summary

8. Fees, payment terms and Childcare Offer for Wales

Payments are due on the 1st of the month. A £25 late payment fee applies after the 10th of the month.

A late collection fee of £10 applies if the nursery is not notified of a delay, rising to £15 after 15 minutes and £25 after 20 minutes.

Invoice amounts may vary based on the number of days in the month. Bijou offers a 10% sibling discount.

Extra sessions are subject to availability and, once booked, cannot be swapped.

If using the Childcare Offer for Wales, funded hours do not include meals, snacks, activities, transport, or certain additional charges. Meals are charged at £3.00 per meal and snacks at 90p per snack.

I confirm that I understand the fees, payment dates, late payment fees, and late collection charges described above
I understand that the Childcare Offer for Wales does not cover all charges and that meals, snacks, activities, transport, and other extras may still apply

9. Medical, health and welfare information

Doctor details

Doctor name
Doctor telephone
Doctor postcode
Doctor address

Health visitor details

Health visitor name
Health visitor telephone
Health visitor postcode
Health visitor address
Does your child have any allergies?
Allergy details
Does your child have any medical conditions?
Medical condition details
Does your child take regular medication?
Medication details
Does your child attend another setting?
Other setting details
Is any agency involved with your child?
Agency contact details
Any procedures not permitted in an emergency?
Procedure details
Cultural or dietary requirements
Are vaccinations up to date?
Vaccination notes

10. Vaccination checklist

DTaP / IPV / Hib - 8 weeks
PCV - 8 weeks
Rotavirus - 8 weeks
MenB - 8 weeks
DTaP / IPV / Hib - 12 weeks
Rotavirus - 12 weeks
DTaP / IPV / Hib - 16 weeks
MenB - 16 weeks
PCV - 16 weeks
MMR - 1 year
MenB booster - 1 year
Hib / MenC - 1 year
PCV - 1 year
Influenza - 2 to 8 years
MMR - 3 years 4 months
Pre-school booster - 3 years 4 months

11. Policies, permissions and declarations

Please review the nursery policies and procedures before returning this form. These declarations mirror the online application and should all be completed by the parent or carer.

I confirm that I have read Bijou Day Nursery & Creche policies and procedures
I confirm acceptance of the enrolment contract and understand the fee structure and charges
I give permission for the nursery to apply sun / nappy / barrier cream
I give permission for the nursery to wash / change my child in the event of an emergency toilet accident
I give permission for the nursery to take appropriate action in the event of illness, accident or emergency
I give permission for the nursery to administer medication if needed by the child
I give permission for my child to leave the nursery premises with the appropriate members of staff
I give permission for my child to be taken / collected in a staff member's car or dedicated vehicle
I confirm that the answers in this application are true to the best of my knowledge and I will inform the nursery of any changes
I give permission to Bijou Day Nursery & Creche Ltd to process the data in this form in accordance with GDPR regulations
I consent to Bijou Day Nursery & Creche Ltd sending me information about their products and services

Photo permissions

  • Photographic evidence to be shared amongst parents of our nursery: Yes / No
  • Photographic evidence to be used for developmental files: Yes / No
  • Media photos (website, leaflets, local press, etc): Yes / No
  • Newsletter / website display: Yes / No

12. Signature section

Parent / carer full name
Date
Signature

Bijou Nursery printable application form