Little Stars Nurseries Child Enrolment Form

Your details will be treated in the strictest confidence and all details kept secure.
Which nursery do you wish to enrol your child at? *
 Alloa 
 Falkirk 
 Glasgow 
 Stirling 
Full name of child (if known):
Date of birth (or due date): *

DD		/
MM		/
YYYY
Home Address: *
Please enter the address of the main parent/carer.
Street Address *
Please enter the address of the main parent/carer.
Address Line 2
Please enter the address of the main parent/carer.
City *
Please enter the address of the main parent/carer.
State / Province / Region *
Please enter the address of the main parent/carer.
Postal / Zip Code *
Please enter the address of the main parent/carer.
Country *
Please enter the address of the main parent/carer.
Home Telephone Number: *
Email Address: *
Confirm *
Full name(s) of parent(s)/carer(s) *
Mother's Work Number:
Mother's Mobile Number: *
Father's Work Number:
Father's Mobile Number:
Please indicate the days and times you wish your child to attend: *
AM Session: 8am-1pm
PM Session: 1pm-6pm
Full Day: 8am-6pm

Monday to Friday
When do you wish your child to start attending from: *

DD		/
MM		/
YYYY
If no exact day known please put from the start of the month and year you wish.
How did you hear about us? *

Declaration

I/We wish to apply for admission to Little Stars Nursery for the above named child. I/We have read the terms and conditions of the nursery and agree to comply with them and any other conditions which may be required in the future.
Name: *
Prefix
First *
Last *
Suffix
Date:

DD		/
MM		/
YYYY
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