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info@littleheartspreschools.com

Registration

This is the description for Registration process

CHILD’S DETAILS

* Fill the form completely in one sitting itself. Questions marked with red asterisk mark are mandatory. Do not use back button or refresh button while filling the form. *

    Child Details

  •  
  •  
  • Sex:*

  •  
  • YES NO
    Person Company  
     

SIBLING INFORMATION

    SIBLING INFORMATION

  • YES NO


MEDICAL HISTORY

    MEDICAL HISTORY

  • Is it possible that your child may require special educational needs support?   Yes No
  • Has your child encountered any difficulties at his/her previous Nursery?   Yes No
  • Has your child any developmental problems and or medical conditions?    Yes No

OTHER FACTORS

    OTHER FACTORS

  • Are there any family circumstances that you feel we should be aware of?   Yes No
  • Summarise your child’s food restrictions / special diet / fears, etc.   Yes No

FAMILY DETAILS

    FAMILY DETAILS

  • Upload Father's Signature
  • Upload Mother's Signature

OPTIONAL SERVICES

    OPTIONAL SERVICES

  • We are interested in the optional services below for our child, and understand that the Fees for these are charged separately from the Pre-school Tuition Fees. Yes No Yes No Yes No

MEDICAL INFORMATION FORM

    MEDICAL INFORMATION FORM

  • MEDICAL HISTORY

    Does your child suffer from any of the following: Yes No Yes No
  • OTHER MEDICAL INFORMATION

    Yes No Yes No
  • EMERGENCY CONTACT

    PERSON TO CONTACT IN CASE OF EMERGENCY IF PARENTS ARE NOT AVAILABLE:
  • DOCTOR’S DETAILS

VACCINATION INFORMATION

    VACCINATION INFORMATION

  • IMMUNISATION SCHEDULE

  • At Birth
    Yes No
    BCG, Hepatitis B, Oral Polion
  • 2 Months
    Yes No
    Pentavent 1 : (Diphtheria, Pertussis, Tetanus, H. influenzae B, Hep B, Oral Polio)
  • 4 Months
    Yes No
    Pentavent 2 : (Diphtheria, Pertussis, Tetanus, H. influenzae B, Hep B, Oral Polio)
  • 6 Months
    Yes No
    Pentavent 3 : (Diphtheria, Pertussis, Tetanus, H. influenzae B, Hep B, Oral Polio)
  • 12 Months
    Yes No
    MMR (Measles, Mumps and Rubella)
  • 18 Months
    Yes No
    Tetravent : (Diphtheria, Pertussis, Tetanus, H. influenzae B, Hep B, Oral Polio)
  • 4-5 Years
    Yes No
    Oral Polio, Measles, Mumps and Rubella, Diphtheria, Tetanus
  • OPTIONAL VACCINES

  • 2 Months
    Yes No
    Prevnar, Rotarix
  • 4 Months
    Yes No
    Prevnar, Rotarix
  • 6 Months
    Yes No
    Prevnar
  • 12-13 Months
    Yes No
    Varicella
  • 24 Months
    Yes No
    Hep. A,Maningococcal, Typhoid fever
  • 30 Months
    Yes No
    Hep. A
  • 4-5 Years
    Yes No
    Varicella booster
  • Annual Vaccine
    Yes No
    Influenza


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