1 Child details 2 Required sessions 3 Your details 4 Payment Do you have any children already attending the Nursery? Do you.* Yes, I currently have a child/children attending Green Roots Nursery. No, I do not currently have a child/children attending; I am registering for the first time with Green Roots Nursery. New child 1 – registration Registration child 1 status yes Child first name* Child surname* Date of birth or due date* Date Format: DD slash MM slash YYYY Gender* Male Female Unknown Does your child suffer from any severe medical conditions or allergies?* Please read Clause 8.3 of our terms & conditions. Yes No If Yes, what are the conditions or allergies?* Add another child New child 2 – registration Registration child 2 status yes Child first name* Child surname* Date of birth or due date* Date Format: DD slash MM slash YYYY Gender* Male Female Unknown Does your child suffer from any severe medical conditions or allergies?* Please read Clause 8.3 of our terms & conditions. Yes No If Yes, what are the conditions or allergies?* Add another childRemove this child New child 3 – registration Registration child 3 status yes Child first name* Child surname* Date of birth or due date* Date Format: DD slash MM slash YYYY Gender* Male Female Unknown Does your child suffer from any severe medical conditions or allergies?* Please read Clause 8.3 of our terms & conditions. Yes No If Yes, what are the conditions or allergies?* Remove this child New child 1 – required sessions Monday Early start(07.30-08.00) Morning(08.00-13.00) Afternoon(13.00-18.00) School Day(08.00-16.00) Full day(08.00-18.00) Tuesday Early start(07.30-08.00) Morning(08.00-13.00) Afternoon(13.00-18.00) School Day(08.00-16.00) Full day(08.00-18.00) Wednesday Early start(07.30-08.00) Morning(08.00-13.00) Afternoon(13.00-18.00) School Day(08.00-16.00) Full day(08.00-18.00) Thursday Early start(07.30-08.00) Morning(08.00-13.00) Afternoon(13.00-18.00) School Day(08.00-16.00) Full day(08.00-18.00) Friday Early start(07.30-08.00) Morning(08.00-13.00) Afternoon(13.00-18.00) School Day(08.00-16.00) Full day(08.00-18.00) If the sessions that you have requested are not available, are you open to alternative days?* Yes No Please specify your preferred start date at Green Roots Nursery.* Date Format: DD slash MM slash YYYY Please specify the year that you expect your child to be starting primary school* Select a year20222023202420252026202720282029203020312032 New child 2 – required sessions Monday Early start(07.30-08.00) Morning(08.00-13.00) Afternoon(13.00-18.00) School Day(08.00-16.00) Full day(08.00-18.00) Tuesday Early start(07.30-08.00) Morning(08.00-13.00) Afternoon(13.00-18.00) School Day(08.00-16.00) Full day(08.00-18.00) Wednesday Early start(07.30-08.00) Morning(08.00-13.00) Afternoon(13.00-18.00) School Day(08.00-16.00) Full day(08.00-18.00) Thursday Early start(07.30-08.00) Morning(08.00-13.00) Afternoon(13.00-18.00) School Day(08.00-16.00) Full day(08.00-18.00) Friday Early start(07.30-08.00) Morning(08.00-13.00) Afternoon(13.00-18.00) School Day(08.00-16.00) Full day(08.00-18.00) If the sessions that you have requested are not available, are you open to alternative days?* Yes No Please specify your preferred start date at Green Roots Nursery.* Date Format: DD slash MM slash YYYY Please specify the year that you expect your child to be starting primary school* Select a year2022202320242025202620272028202920302031203220222023202420252026202720282029203020312032 New child 3 – required sessions Monday Early start(07.30-08.00) Morning(08.00-13.00) Afternoon(13.00-18.00) School Day(08.00-16.00) Full day(08.00-18.00) Tuesday Early start(07.30-08.00) Morning(08.00-13.00) Afternoon(13.00-18.00) School Day(08.00-16.00) Full day(08.00-18.00) Wednesday Early start(07.30-08.00) Morning(08.00-13.00) Afternoon(13.00-18.00) School Day(08.00-16.00) Full day(08.00-18.00) Thursday Early start(07.30-08.00) Morning(08.00-13.00) Afternoon(13.00-18.00) School Day(08.00-16.00) Full day(08.00-18.00) Friday Early start(07.30-08.00) Morning(08.00-13.00) Afternoon(13.00-18.00) School Day(08.00-16.00) Full day(08.00-18.00) If the sessions that you have requested are not available, are you open to alternative days?* Yes No Please specify your preferred start date at Green Roots Nursery.* Date Format: DD slash MM slash YYYY Please specify the year that you expect your child to be starting primary school* Select a year202220232024202520262027202820292030203120322022202320242025202620272028202920302031203220222023202420252026202720282029203020312032 Parent/Guardian details Your details including your email address are essential information, which we will only use to provide a childcare service to you. By providing us with these details you are giving Green Roots consent to hold and process your data and send you information. Please see our Policies and Privacy Notice for more information. Title* SelectMr.Mrs.Miss.Ms.Other First name* Surname* Relationship to child* Address* Street Address Address Line 2 Town/City County Postcode Email address* Home phone number* Mobile number* Parental responsibility* Please tick the box to confirm you have parental responsibility for the child/children.* We are only able to accept a booking from a person with parental responsibility for the child/children. Please provide details of any special requirements or additional information here How did you hear about Green Roots Nursery?* SelectInternet searchSocial mediaWord of mouthDrove pastAdvertOther Deposit, per family (Refundable) Registration fee, per child (Non-refundable) Total £ 0.00 Your items Credit Card* Card Details Cardholder Name Read Terms and Conditions.* Please tick to confirm that you have read Green Roots Nursery Terms and Conditions and that you agree to be bound by them* Please retain a copy for your own records. Should any provision of these terms and conditions be found to be unlawful then that provision shall be removed but the agreement itself shall remain in full force and effect. Your statutory rights are not affected by these terms and conditions. Please see our Policies and Privacy Notice for information regarding the processing of your data.
