Section A | Your Child

*Child's Firstname:   

*Child's Surname:     

                      *Sex:           *Child's Age :

*Name & Number Of Parents/Guardian


*Contact Number:     


- Below please record your preferences – select (Please choose a minimum of 2 full days or 3 part-time sessions)






DATA PROTECTION STATEMENT – The information on this form is required by the Nursery for the purpose of processing your application. The information is covered by the provisions of the Data Protection Act 1998. Your signature to the form is deemed to be an authorisation by you to allow the Nursery to process and retain the information for the purpose(s) stated.

Regal Brook Nursery
38 Upper Wickham Lane,
Welling, Kent
DA16 3HF

For further assistance please call us on 0203 754 1851