Parents are required to complete a contract, a child record form, a parental permission form, and a policy agreement form. Parents are also required to provide me with relevant information about their child. Examples of these forms are shown below and further copies will be provided for you to complete.


Confirmation of Policies Form



Please confirm by signing below, that you have received a copy of my Policies and Information by email and that you are aware that you can access my folder of Policies, Information and Qualifications on either of my work premises during working hours.



Parent / Guardian of _________________________________________________


Parent / Guardian Name _____________________________________________




Date __________________________________________________________________



Permission Form


Please strike out any of the activities etc. below that you do not wish your child to receive. Please note that a lack of permission may result in me not being able to care for your child.  You are giving prior permission for your child to experience the activities and care that remain on the form. Activities may differ between my home premises and St Paul’s Primary School premises.

I give permission for

(Enter Child’s name) _________________________________________________

to receive the following types of care / experiences /activities: 


Parent / Guardian’s name: ___________________________________________


Signature___________________________________ Date ___________________


First Aid for minor incidents / plasters

Emergency First Aid

School collection / drop off

Sun cream

Contact with pets

Use of public / private transport


Use of play park apparatus

St Paul’s School Clubs (other fees may apply)

Dappa Dance Club (other fees may apply)

To feature in film/photographs

To feature on the St.Paul's P.A.L.S website (even if children subsequently leave our care)

To feature in printed media

Paddling pool


Face paints

Age appropriate internet access, film, TV and computer games

Messy play e.g. Play doh, clay, water, sand, paint, chalk etc.


Agreement Form


Please complete and sign to say that you agree to the following requirements:


(Enter Child’s Name) _______________________________________ will not be allowed to leave the premises with anyone who cannot provide the following password____________________________________________________.


Your child will be encouraged to follow British Values.


Your child’s belongings should be clearly labeled. I will not be held responsible for loss or damage.


You must notify me of all illnesses. Your child may not be accepted for care in some instances.


All paperwork must be completed. Records may be stored digitally (I am registered with ICO) and on paper.


Food should only be supplied by prior agreement and should be given to me on arrival (other children on the premises may have allergies)


Please ensure your family is aware of health and safety issues on my work premises and that they behave in a way that is respectful of others and their property and is mindful of British Values.


Please supply a water bottle, sun cream, sun hat, and weather appropriate outdoor clothing. Please ensure that morning session children have the appropriate uniform and equipment for school.


It is my duty to safeguard the children in my care and report to the appropriate bodies where necessary.


A registered assistant, Nadine Shaw, may also work with your child (sometimes unsupervised, for short periods of time, if your child is aged eight or over). 

In an emergancy your children may be cared for by another suitable person.


Please do not use phones and other photographic devices whilst on my premises. Children's phones etc. must be given to me for safekeeping until they leave the premises.


All fees must be paid in advance. Late fees and late collections may incur a charge.


Children are expected to behave appropriately at all times.

Parent / Guardian Name __________________________



Signature _________________________________________



Date _______________________________________________



Permission to Collect a Child from School


The Headteacher

St. Paul’s C.E. (C) Primary School

Garden Street


ST17 4BT


Dear Headteacher,


I give permission for Mo Tierney, to collect my child


(Enter child’s name) _________________________________________________


from School (including school clubs). If she cannot collect my child for any reason, she will contact you and a parent /guardian as soon as possible. I will notify you if this situation changes.



Parent / Guardian __________________________________________________








Permission to communicate with St. Paul's Primary School about Pupils in my care



I agree that Mo Tierney may discuss matters relating to my child with school staff  and pass this information on to me.  She may also pass on to you messages and my views and requirements regarding my child. I will inform school if this situation changes.


Child's Name _______________________________________________________



Parent / Guardian Name ___________________________________________



Parent  / Guardian Signature _______________________________________



Date _______________________________________________________________



Permission for an Unaccompanied Child to travel to/from School or Childminding Premises


In order to enable independence, some children may be able to travel  between home, school and my work premises without an adult.


I confirm that my child __________________________________________is of a suitable age, ability and maturity to make these trips unaccompanied by an adult and accept that if Mo Tierney does not agree, my child will  not be allowed to travel unaccompanied by an adult.


I give permission for my child to travel to /from School (including school clubs), home or the childminding premises unaccompanied by a parent, carer or the childminder.


If my child is traveling from home/ school to the childminding premises I understand that Mo Tierney will contact me should my child not arrive promptly and that it will be my responsibility to find my child.

If my child is walking home unaccompanied from the childminding premises, I understand that Mo Tierney will contact me when my child leaves her care and that it is then my responsibility to keep track of my child.

I understand that Mo Tierney will check that children have arrived at primary school but that parents needing confirmation that their child has arrived at high school, should contact the appropriate school themselves.


I understand that if Mo Tierney does not feel that my child is capable of making an unaccompanied trip on any particular occasion due to illness, safety or behavioural issues etc, he or she will not be allowed to travel alone and a parent / guardian may be required to collect the child.


Parent / Guardian___________________________________________________


Signature: ___________________________________________________________


Date: _________________________________________________________________