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Start Date
Name of the Child
Address
Name of creche attending
Date of birth
Parent/guardians name
Daytime contact number
Who will be authorised to collect your child
Who may be contacted in an emergency
Family Doctor
Tel
Medical history
Any known allergies
Is there anything else we should know about your child? Please give details
Measles / Mumps / Rubella
Yes
No
Diphtheria /Tetanus / Whooping cough
Yes
No
Meningitis C
Yes
No
Tuberculosis /B.C.G
Yes
No
H.I.B
Yes
No
Is special care and attention required
Yes
No
If yes please give details
Email Address
Please specify which days your child will be attending:
Type of service required:
FULL DAY CARE
MONTESSORI
OTHER
Proposed method of payment:
CHEQUE
DIRECT DEBIT
BANK DRAFT
Where did you hear about us:
Parents responsibility.
Parents are required to keep staff updated with regards to change of contact numbers and work numbers.
Inform Pugwash Bay of any food or substance allergies.
Ensure that contact phone number is reachable at all times.
Ensure all food containers-Drinking bottles are clearly labelled.
All clothing is labelled. Parents must be aware that Pugwash Bay can not be responsible for items of clothing if they go missing.
To abide to our healthy eating policy.
I have read the terms and conditions of the fees policy.
