Old CourtCommunity Pre-schoolStation Road, Wootton Bassett, Swindon. SN4

8QY.Tel No 01793 849783

REGISTRATION FORMFull name of childKnown asDate of birthNames of parents

Home address

Post codeTelephone numberEmail AddressPreferred Sessions

Do you feel your child has any special needs? If yes, please give details

YES / NO

I consent to share my details with Wootton Bassett Childrens Centre

YES/NO

Will you be claiming funding to cover the sessions?Parent/Guardian’s signature:Date:Office Use OnlyDate of Birth VerifiedSigned/Date

Passport/B Cert

Old CourtCommunity Pre-schoolStation Road, Wootton Bassett, Swindon. SN4

8QY.Tel No 01793 849783

REGISTRATION FORM

Full name of childKnown asDate of birthNames of parents

Home address

Post codeTelephone numberEmail AddressPreferred Sessions

Do you feel your child has any special needs? If yes, please give details

YES / NO

I consent to share my details with Wootton Bassett Childrens Centre

YES/NO

Will you be claiming funding to cover the sessions?Parent/Guardian’s signature:Date:Office Use OnlyDate of Birth VerifiedSigned/Date

Passport/B Cert