Name of Child :

Address:

Date of Birth:

Home Tel:

Religion:

Work Tel:

Gender:

Mobile Tel:

Emergency Contact

Emergency Tel:

2nd Contact :

2nd Tel:

Medical history (inc. vaccinations & allergies):

Doctor’s Name, Address & Tel:

Morning /Afternoon Session:

Drink for snack time - Water or Juice ?

Food for snack time - Biscuit, Fruit, or Both ?

Which term and year would you like your child to start: January, April or September

Do you have an approximate planned leaving date and if so, when is it ?

Please provide any further information that may be relevant to your child which may help whilst he/she is with us. All information provided will be kept in the strictest of confidence.

Please post your completed registration form, together with your non-refundable Registration Fee of £40 made payable to:
"Little Anqels", 10 Adelaide Close, Stanmore, Middx, HA7 3EL