Child's Details

Full Name (required)

Date of Birth (required)
12345678910111213141516171819202122232425262728293031 JanFebMarAprMayJunJulAugSepOctNovDec 20182019202020212022202320242025202620272028

Gender:
—Please choose an option—malefemaleprefer not to answer

Religion

Parent #1 Details

Full Name (required)

Relationship to child
—Please choose an option—MotherFatherOther

Address (required)

Postcode

Telephone Home (required - use mobile if no home number)

Telephone Mobile (required - use home if no mobile number)

Telephone Work

Email Address (required)

Parent #2 Details

Full Name (required)

Relationship to child
—Please choose an option—MotherFatherOther

Address (required)

Postcode

Telephone Home (required - use mobile if no home number)

Telephone Mobile (required - use home if no mobile number)

Telephone Work

Email Address (required)

Enrolment Details

Start Date (required)
12345678910111213141516171819202122232425262728293031 JanFebMarAprMayJunJulAugSepOctNovDec 20242025202620272028

Sessions required

Mon Tue Wed Thu Fri

Please note: You will need to allow a week before this date for the settling-in process.

Choose your child's pathway

During your child's time at Chrysalis, there will be an option of two pathways you can choose from depending on your preference for the Pre-School. Please tick below to indicate your preference so we can ensure you are registered with the correct database. Please note if you wish to change your pathway at a later date, this will be subject to availability and staffing at the time.

All children under 2 of age will start in Caterpillars and transition into the Chrysalis room at approximately 14 months (or developmentally ready) until around 2 years.

2 year onwards pathways:

Option 1

Butterfly Room - Approx 2 years until the term after turning 3 years (located at the Church Hill site)
Foxes Room – Term after their 3rd birthday until their transition to school (located at the Cricket Club)

Option 2

Ladybird Room - Approx 2 years until the September before starting school (located at the 125, High Rd site)
Bumblebee Room – The September before starting school until their transition to school (located at the 125, High Rd site)

Have you already been to visit the nursery?
—Please choose an option—yesno
(If not, please call on 020 8508 1888 (Churchill) or 020 8502 2912 (High Road) and we can get this booked in for you)

Has your child attended any previous childcare settings? (this includes a nursery or child minder)
—Please choose an option—yesno
If yes, please list all settings

Does your child have any additional needs?

Additional Information

Where did you hear about Chrysalis?

please check that you have filled in all the required fields before pressing send.

Data Protection
Should you not join Chrysalis Nursery and Pre-school for any reason, we will retain this form until you request to be removed from the waiting list or until your child reaches 5 years of age.