Children's Centre Registration Form

Children's details
We only require the details of your children that are currently aged 0-5 years
First child
Name

First

Last
Date of birth (DD/MM/YYYY)
Gender
Disability
Nature of disability
Ethnicity
If any other background, please state:
Child's first language:
Second child
Name

First

Last
Date of birth (DD/MM/YYYY)
Gender
Disability
Nature of disability
Ethnicity
If any other background, please state:
Child's first language:
Third child
Name

First

Last
Date of birth (DD/MM/YYYY)
Gender
Disability
Nature of disability
Ethnicity
If 'any other background', please state:
Child's first language:
Fourth child
Name

First

Last
Date of birth (DD/MM/YYYY)
Gender
Disability
Nature of disability
Ethnicity
If 'any other background', please state:
Child's first language:
If 'any other background', please state:

Parent or Legal Guardian details
Please provide details of parent or legal guardian
Name

First

Last
Address

Address Line 1

Address Line 2

City

County

Postcode

Country
Landline
Mobile
Email
Date of birth
Gender
Ethnicity
If any other background, please state:
First language:
Relationship to child(ren):
Parent or Legal Guardian details (2nd)
Please provide details of 2nd parent or legal guardian
Name

First

Last
Address

Address Line 1

Address Line 2

City

County

Postcode

Country
Landline
Mobile
Date of birth
Email
Gender
Ethnicitiy
If any other background, please state:
First language:
Relationship to child(ren):
Additional Information
By answering the following questions, you are helping us to shape the service we provide to best meet the needs of you and your children. All the information you provide will be kept secure within Trafford Council.
Do you consider yourself to be a lone parent?:
Do you, your partner or any member of your family have a disability?:
If yes, please state below, name and nature of the disability
Are you or your partner that you live with on a low income or in receipt of Universal Credit?
Are you interested in any particular services or activities?