Call us for further information
and to register your child today
0526600041 or 0526600042

Admission Form

ABOUT YOUR CHILD

Name
Family Name
Nationality
Gender :
Age
Religion

ABOUT YOUR FAMILY

Mother Name
Father Name
Place of Work
Place of Work
Mobile
Mobile
Email Address
Email Address
Office Tel
Office Tel

ABOUT YOUR HOME

Home Tel :
PO Box
Address Line 1
Address Line 2

IN CASE OF EMERGENCY

1ST Contact Person
Place of Work
Place of Resident
Contact Number
Relationship
2ND Contact Person
Place of Work
Place of Resident
Contact Numbe r
Relationship

Authorized persons to collect your child from Monroe’s Nursery

I / We authorize the following persons to collect our child from nursery.
1st Name
Telephone
2nd Name
Telephone

Non Prescriptive Medication Policy

Calpol
Yes No
Insect Repellent
Yes No
First-Aid Ointment
Yes No

Medical Form

BASIC INFORMATION

Childs Name
Family Name
Nationality
Gender
Date Of Birth
Emergency Contact
Doctor Name
Mother Contact
Clinic
Father Contact :
Doctor Contact
Nanny Contact

MEDICAL HISTORY

Has/is your child suffering from any of the following conditions/illnesses:
HEPATITIS
DIABETES
EPILEPSY
ASTHMA
THALASSEMIA
MUMPS
POLIO
MEASLES
WHOOPING COUGH
DYSENTERY
RUBELLA
TUBERCULOSIS
Other

VACCINATIONS

Please identify if your child has been vaccinated
DPT1
DPT2
DPT3
BCG, Tuberculosis
HEPATITIS A
CHICKEN POX
POLIO
HEPATITIS B
MMR
Other

Category

3 months+
1 year +
2 year +
3 year +

Child Information

Child Full Name
I am
Male Female
My Date of Birth
DD/MM/YYY Y

Nursery Requirement

Standard Nursery 8:30am – 1:00pm
5 Days
3 Days
2 Days
Afternoon Nursery 2:00pm – 5:30pm
5 Days
3 Days
2 Days
Breakfast Club
Afternoon Club (A)
Afternoon Club (B)

Knowing the Child Form

My Nickname:
My Favorite Toy:
My Favorite Person:
My Brother is:
My Sister is:
My Pets are:
My Nanny is:
My comforter is:
I spend most my Time with:
I find leaving Mum & Dad
difficult:
I can speak clearly i n:
I can use the toilet :
I don’t really like:
I have an allergy to :
Date

Enquiry form

Enquiry is About
Your Full Name
Email Address
Mobile Number
How do you know about us
Message