Newpark Childcare

Parent / Guardian Information

First Name *

Last Name *

Mobile Phone Number *

Relationship to Child *

Address Line 1 *

Address Line 2 *

Eircode *

Email Address *

How did you hear about Newpark Childcare *

Emergency Contact First Name *

Emergency Contact Last Name *

Emergency Contact Mobile Phone Number *

Emergency Contact Relationship *

Go Back

Child's First Name *

Child's Last Name *

Child's Gender *

Child's Date of Birth *

Care Required *

Number of Days per Week *

Expected Start Date *

Medical Conditions or Allergies

Special Accommodations

Go Back

6-in-1 *

MenB *

MenC *

4-in-1 *

MMR *

Chickenpox *

PCV *

Rotavirus *

Go Back

Please indicate your permission for the following:

Permission to Seek Emergency Medical Treatment

Permission to be Photographed

Permission for Outings / Trips

Permission to Apply Sunscreen

Permission to Administer Non-Prescription Medication

Permission to Share Information with Other Professionals

Go Back

Parent / Guardian Signature *

Date Signed *

Declaration *

I confirm that the information provided is complete and accurate.

I understand that childcare places are offered on a full-time basis first.

I understand that completing this form does not guarantee a place and does not constitute an offer of a place or a binding agreement with Newpark Childcare.

I confirm that I have read, understood and agree to the Newpark Childcare Terms of Service Agreement and Privacy Policy.

Thank you for completing the Newpark Childcare Registration of Interest Form. Our team will respond to you within 2-3 working days.

There was an error trying to send your message. Please try again later.

Registration of Interest Form

Parent / Guardian Information

Emergency Contact

Child Information

Vaccination Information

Permissions

Parent / Guardian Declaration