Jigsaw Curzon House Day Nursery

Jigsaw Curzon House Registration Form

Please complete every required section, select the attendance sessions required, then sign online before submitting.

Child Details

Full name of child

Date of birth

Gender

Address

Post code

Home/house telephone number

Child's first language

Religion

Ethnicity

Requested starting date

Attendance Required

Day	Full Day	Half Day am	Half Day pm
Monday	Select	Select	Select
Tuesday	Select	Select	Select
Wednesday	Select	Select	Select
Thursday	Select	Select	Select
Friday	Select	Select	Select

Parent / Carer One

Full name

Title

Relationship to child

Personal email

Mobile telephone

Work telephone

Employer's name and address

Parent / Carer Two

Full name

Title

Relationship to child

Personal email

Mobile telephone

Works telephone

Employer's name and address

Medical and Care Information

Child's doctor name and address

Doctor telephone no.

Health visitor telephone no.

Child's health visitor name and address

Health visitor email address

Allergies, medical conditions or special care needs

Immunisations your child has had to date

Food or drink allergies and special dietary requirements

Anything else we should know about your child?

Agreement / Declaration

I enclose an administration fee of £55.00 which reserves a place for my child at Jigsaw Curzon House Day Nursery and which I understand is non-refundable after a place has been confirmed.

I agree to pay fees against an invoice for the first month, or part of a month, attended by my child; and thereafter monthly in advance, due on the first day of each calendar month.

I have read and understood the nursery information given by Jigsaw along with the registration form and I understand that refunds will not be made for periods of absence.

I understand that I can access all the nursery policies on the nursery app and have signed up to this app.

I undertake to give two months' notice in writing if I wish to change the date on which my child is due to start the nursery. If two months' notice is not given I will be charged from the date stated on my registration form.

I undertake to give one month's notice in writing when my child's place on any day is no longer required, and to pay fees for that month.

I have read and understood all policies and procedures including the Privacy Policy which states how all information provided by myself will be used and stored.

I understand my rights outlined in the GDPR Privacy Policy and opt in for Jigsaw to store mine and my child's personal data as outlined in the policy.

I accept all Jigsaw Curzon House Day Nursery's policies, procedures, terms and conditions.

I confirm that I have read and accept the agreement and declaration.

Online Signature

Full name