Cornerstone Academy: About Us

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Parents Registration Form
Name of Child:
Date of Birth:
Primary carer’s Name:
Address:
Daytime telephone:
Ethnic Origin:
Religion:
Relationship to Child:
Name of School:
Address of School:
Telephone of School:
Teacher’s Name:
Doctor’s Name:
Doctor’s Address:
Doctor’s Telephone:
Medical Conditions/ Allergies :
Special dietary needs:
Do you give consent for urgent medical treatment to be given to your child in your absence? i.e. administration of paracetamol or taking child to the hospital. Yes No
Emergency Contact
Name:
Address:
Telephone:
Relationship to child:
Name:
Address:
Telephone:
Relationship to child:
Employment Status
Are presently in employment?:	Yes No
If yes, please answer the next two questions.
Are you receiving Working tax credit?.	Yes No
Are you receiving Child tax credit?.	Yes No
ABOUT YOUR CHILD
Child’s favourite toys:
Child’s special routine:
Child’s sleep pattern:
Child’s Feeding routine:
Face Painting Permission
Child’s name:
Do you give permission for my child’s face to be painted.
	Yes No
Photographing Permission
Do you give permission for my child’s photograph to be taken during any activity /session within the centre and not to be used for any other purposes other than that of the organisation’s displays/records/publications.
	Yes No