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Open Access Registration Form

If you haven't used a children's centre before you will need to register your details before using the centre.
This can be done before you visit using this form, but you can also still register in person at the children's centre.

Main carer (for example mother or father)

Date of birth *
Date of birth
Are you a lone parent?
Are you a lone parent?
If you are pregnant, what is your due date?
If you are pregnant, what is your due date?
What is your employment status?
What is your employment status?
Is English your first language?
Is English your first language?
Do you smoke?
Do you smoke?
How did you hear about us?
How did you hear about us?

Equalities monitoring information

This information will be treated as confidential. We will use this information to help us with our planning and to make sure that all families receive the services they deserve.
Do you have any special educational needs?
Do you have any special educational needs?
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