Moor House Nurseries Pre registration form

Childs Name: *

Date of Birth / Expected Due Date: *

Ethnic Origin: *

Relegion: *

Mothers Name: *

Mothers Tel No: *

Fathers Name: *

Fathers Tel No: *

Home Address: *

Home Tel No: *

Mobile Tel No: *

Date you would like to start: *

Days / sessions required (please indicate times if known)

Monday Start:

Monday End:

Tuesday Start:

Tuesday End:

Wednesday Start:

Wednesday End:

Thursday Start:

Thursday End:

Friday Start:

Friday End:

Possible changes to the initial booking:

 
Fields marked with an asterisk * must be filled in.