Dunalley Nursery and Pre-school Application for Admission

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1. Contact Details
Page 1 of 13

1. YOUR CHILD

Preferred Start Date:
Legal Forename:
Middle Name(s):
Legal Surname:
Preferred Names (if different from above):
Date of Birth:
Gender:
Home Address:
Postcode:
Family Email Address:
Siblings at Dunalley (if any): Name & Class

2. Parents / Guardians

	Parent 1	Parent 2	Step-parent (if any)	Guardian (if any)
Title (Mr/Mrs/Miss/Ms)	Title (Mr/Mrs/Miss/Ms) Parent 1	Title (Mr/Mrs/Miss/Ms) Parent 2	Title (Mr/Mrs/Miss/Ms) Step-parent (if any)	Title (Mr/Mrs/Miss/Ms) Guardian (if any)
Forename	Forename Parent 1	Forename Parent 2	Forename Step-parent (if any)	Forename Guardian (if any)
Surname	Surname Parent 1	Surname Parent 2	Surname Step-parent (if any)	Surname Guardian (if any)
Does this person have parental responsibility Yes/No	Does this person have parental responsibility Yes/No Parent 1	Does this person have parental responsibility Yes/No Parent 2	Does this person have parental responsibility Yes/No Step-parent (if any)	Does this person have parental responsibility Yes/No Guardian (if any)
Emergency Contact Order: 1st, 2nd etc. Mother normally 1st	Emergency Contact Order: 1st, 2nd etc. Mother normally 1st Parent 1	Emergency Contact Order: 1st, 2nd etc. Mother normally 1st Parent 2	Emergency Contact Order: 1st, 2nd etc. Mother normally 1st Step-parent (if any)	Emergency Contact Order: 1st, 2nd etc. Mother normally 1st Guardian (if any)
Mobile Number	Mobile Number Parent 1	Mobile Number Parent 2	Mobile Number Step-parent (if any)	Mobile Number Guardian (if any)
Home Tel. Number	Home Tel. Number Parent 1	Home Tel. Number Parent 2	Home Tel. Number Step-parent (if any)	Home Tel. Number Guardian (if any)
Work Tel. Number	Work Tel. Number Parent 1	Work Tel. Number Parent 2	Work Tel. Number Step-parent (if any)	Work Tel. Number Guardian (if any)
Address if different from child's address	Address if different from child's address Parent 1	Address if different from child's address Parent 2	Address if different from child's address Step-parent (if any)	Address if different from child's address Guardian (if any)
Are there any custody issues	Are there any custody issues Parent 1	Are there any custody issues Parent 2	Are there any custody issues Step-parent (if any)	Are there any custody issues Guardian (if any)
Details of Custody Issues	Details of Custody Issues Parent 1	Details of Custody Issues Parent 2	Details of Custody Issues Step-parent (if any)	Details of Custody Issues Guardian (if any)

3. Additional Emergency Contacts to Parents / Guardians (if any) – PLEASE PUT IN PRIORITY ORDER left to right

	Additional Contact 1	Additional Contact 2	Additional Contact 3
Title (Mr/Mrs/Miss/Ms)	Title (Mr/Mrs/Miss/Ms) Additional Contact 1	Title (Mr/Mrs/Miss/Ms) Additional Contact 2	Title (Mr/Mrs/Miss/Ms) Additional Contact 3
Forename	Forename Additional Contact 1	Forename Additional Contact 2	Forename Additional Contact 3
Surname	Surname Additional Contact 1	Surname Additional Contact 2	Surname Additional Contact 3
Mobile Number	Mobile Number Additional Contact 1	Mobile Number Additional Contact 2	Mobile Number Additional Contact 3
Home Tel. Number	Home Tel. Number Additional Contact 1	Home Tel. Number Additional Contact 2	Home Tel. Number Additional Contact 3
Work Tel. Number	Work Tel. Number Additional Contact 1	Work Tel. Number Additional Contact 2	Work Tel. Number Additional Contact 3
Relationship to child	Relationship to child Additional Contact 1	Relationship to child Additional Contact 2	Relationship to child Additional Contact 3