Small World Registration Form

Club or After School only

Please complete the form below and then print it and return with £25.00 registration to

Small World
89 Bagley Wood Road
Kennington
Oxford OX1 5NA

Please return this completed form with a registration fee of £25.00 to
Small World, 89 Bagley Wood Road, Kennington, Oxford, OX1 5NA

Please make cheques payable to Small World Nursery Ltd

Request for a Club or After School Place - Registration

Date (today's)
How did you hear about us? We offer referral incentives ¹
Child's name or "Baby" and future family name
Date of birth
Home address including Postcode
Home telephone
Mother's full name
Mother's contact numbers and e-mail addresses mobile & work & state times as relevant
Father's full name
Father's contact numbers and e-mail addresses mobile & work & state times as relevant
Reference for your account normally your child's surname 8 characters will be used
Sessions required - from (date) and then tick belowon the next page, or describe preferences

Club	Monday	Tuesday	Wednesday	Thursday	Friday
Breakfast
After-School 3pm - 6pm
Other

Are you likely to use the Holiday Club?	Half-terms	Easter	Summer

School Child attends	LEA	Private

Further notes you may wish to add...

Please note that this form places you on our waiting list but does not guarantee you a place.
We will confirm this in writing with an offer of a place.

¹ Details of referral incentives are available on request.

Office use ...
Receipt acknowledged on:		__________
Copied to		Casa	AS
Place confirmed on:		__________
Account	__________		opened on	__________
Registration fee received:			_____________
Deposit	__________	Weekly	__________	Standing order	__________
Deposit invoice sent:		__________	Deposit received:		__________
Entered:		Fees	Deposit	Contact	Register