Child's Surname: 

Child's First Name:                     

Date of Birth: dd12345678910111213141516171819202122232425262728293031  mmmJanFebMarAprMayJunJulAugSepOctNovDec  yyyy201920202021202220232024                   Child's Gender (choose Male or Female from the dropdown list): --MaleFemale

Address:
Town:
County:
Postcode:

 

Telephone:
Mobile:

 

Email Address:

Siblings who have attended pre-school: 

Any special educational or medical reasons you would like to be considered (written professional evidence will be required):

How Cheam Baptist Church Pre-school handles information about you and your child.
Cheam Baptist Church Pre-school will keep the above information about you and your child confidentially and securely. It will not be shared with anyone else. It will only be used to communicate with you regarding a place at the pre-school and will be deleted if your child does not take up the place.

  I consent to information about me and my child being handled by Cheam Baptist Church Pre-school as outlined above.

Parent/Guardian's name:  

 If a member of Cheam Baptist Church please tick.