Early Years Reference

Child's personal details

Name of child*

First Last

Date of birth*

Siblings*

Yes
No

Position in family*

1
2
3
4

What language(s) do you speak at home?*

Allergies, dietary requirements and medical information we need to know about*

Enter "not applicable" if there is nothing we need to be aware of

Does your child go to after school care and if so, on which days?*

Monday
Tuesday
Wednesday
Thursday
Friday
Does not attend after school care

What year will your child enter?*

Nursery
Reception

Proposed starting date*

Has your child previously been to another school?*

Yes
No

Name of the school*

Dates of attendance*

Type of attendance*

Part time
Full time

Language of instruction*

Is your child toilet trained?*

Yes
No

This means they can recognise when they need to go to the toilet, use the toilet independently, deal with their own clothing, wipe themselves when finished, and does not need to wear nappies (diapers) or pull ups.

Does you child prefer to sit or stand to use the toilet?*

Sit
Stand

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Early Years Reference

Step 1 of 3

Child's personal details

Child's personal qualities

Parent / Guardian Details