Family Details Sample Clauses

Family Details. Name Relation If, Alive If, Expired Age (Years) Health Cause of Death Year of Death Father Mother Grandfather Grandmother Brother/Sister Brother/Sister Brother/Sister

Family Details. Mother’s Name Address (If different from child) _ Occupation Day time telephone _ Evening telephone _ Mobile Father’s Name _ Address (If different from child) _ Occupation Day time telephone _ Evening telephone _ Mobile Email (For financials and centre information) Emergency Contacts (In addition to parents details) Name Relationship Telephone Name Relationship Telephone _ Is there any person who is prohibited access to your child? Yes  Name No  Custody order on file? Yes  No  Enrolment Details Days Enrolled: Monday Tuesday Wednesday Thursday Friday Times Enrolled: Total hours: 20 Hours ECE at this service Total hours: 20 Hours ECE at another service Total hours: Parent/Guardian Signature: Date: /_ / 20 Hours ECE Details Is your child receiving 20 Hours ECE for up to six hours per day, 20 hours per week at this service? Yes  No  Is your child receiving 20 Hours ECE at any other services? Yes  No  I hereby declare that my child is not enrolled at another early childhood institution at the same times that he/she is enrolled at Childsplay Unlimited: Parent/Guardian Signature: _ Date: /_ / _ Privacy Statement We are collecting personal information on this enrolment form for the purposes of providing early childhood education for your child. We will use and disclose your child’s information only in accordance with the Privacy Act 1993. Under that Act you have the right to access and request correction of any personal information we hold about you or your child. Details about your child’s identity will be shared with the Ministry of Education so that it can allocate a national student number for your child. This unique identifier will be used for research, statistics, funding, and the measurement of educational outcomes. You can find more information about national student numbers at: xxx.xxxxxx.xxxx.xx/xxxxxxx * Information about acceptable identity verification documents is available online at xxx.xxxx.xxx.xxxx.xx and xxx.xxxxxx.xxxx.xx/xxxxxxx The Ministry recommends that all services keep a copy of the identity verification document of each child who is enrolled at the service. Declaration Please read and agree to the following before signing the application:

Family Details. If married, name of your spouse: ........................................................................................................ Surname:............................................................................................................................................... If employed, profession/duty of your spouse: ..................................................................................... Registered trade name of the company your spouse works for:......................................................... Address of the company your spouse works for: ............................................................................... ...............................................................................................................................................................

Family Details. Current occupation: ............................................................................................................... Currently living in Owned/Rented property (please delete as appropriate) FEES I confirm that if my tender is accepted, I agree to pay £300 non-returnable reservation deposit, which will be counted towards the first month’s rent. SIGNED: ........................................................ DATE: ..............................................

Family Details. Current occupation:................................................................................................................ Currently living in Owned/Rented property (please delete as appropriate) LEGAL FEES I confirm that if my tender is accepted and solicitors instructed, I will pay the agreed proportion of the legal costs in connection with the Tenancy Agreement whether abortive or not. I also agree to pay £200 non-returnable reservation deposit which will be counted towards the first months rent. SIGNED:................................................ DATE:..............................................