Children's Centre Registration

1. Parent/Carer Details (this is the parent/carer we will send letters and information to)*

Other – please specify

First Name *

Surname *

Date of Birth *

Address *

Address line 1

Address line 2

Town

Region

Country

Postcode

Phone and/or mobile

Email Address

2. Language and Ethnicity

Language spoken - English or other (please specify)

Ethnicity

4. Children who live with you

Child One

First name and surname

Date of birth

Ethnicity

Relationship to you

Has disability or special needs

Yes No

Child Two

First name and surname

Date of Birth

Ethnicity

Relationship to you

Has disability or special needs

Yes No

City of York Council