Heavitree Community Pre-school

South Lawn Terrace

Heavitree

Exeter

EX1 2SN

Admission Form

Full name of child: ………………………………………………………………………..........................…… Male / female

Date of birth: ………………………………….......................…

Ethnic Origin:……………………………………..

Parent(s) names: ………………………………………………………………….........................……….....

Home address: …………………………………………………………………………………………………...

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Postcode: ……………………………

Telephone number: …………………………………………………...…………….

Email address:……………………………………………............……...

Has your child any allergies? …………………………………………………………………………

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Has your child any health concerns that Preschool should know about, including asthma, eczema, infectious diseases, major illness, etc?

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Has your child any Educational / Developmental concerns that Preschool should know about? (Includes behavioural, social or emotional needs etc.. or any referral to another agency eg Health Visitor, Honeylands, Paediatrician etc..

YES………….. NO…………… UNSURE…………….

If Yes or Unsure please detail below.

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How did you find out about us? (eg DISC website, local advert, word of mouth, etc)

When would you like to start at pre-school?

Preferred number of days? (Please circle) Mon am pm all-day Tues am pm all-day Wed am pm all-day Thurs am pm all-day Fri am pm all-day No preference

(Although we do our best to accommodate parent preferences, we are unable to guarantee start date or sessions available. Sessions allocated prior to settling in maybe changed or delayed in order to best meet the needs of your child where appropriate. This will always be discussed with you prior to change).