Children centre joining form

Please complete the details below:

Please only use full legal names when completing this form, including middle names.

Applicant's details

Title:

First name(s):

Last name:

Relationship to child:

Address:

Postcode:

Home telephone:

Mobile:

Email:

Date of birth:

Which children's centre are you wishing to join

Husband/wife/partner's details

Relationship to child:

Title:

First name(s):

Last name:

Date of birth:

Child's details

First name(s):

Middle names:

Last name:

Date of birth:

Gender:
Male Female

I electronically agree that the information I have provided can be processed for the purposes set out in the North Somerset Children's Centre Information Sharing Guide and in accordance with the Data Protection Act 1998. I agree that North Somerset Children's Centres can keep this information electronically and enrol me as a member of the Children's Centres.

North Somerset Children's Centre Information Sharing Guide