Pre-registration

Name:

Address:
Please include postcode

Daytime Telephone Number:

Email Address:

Gender:    Male       Female  

Age:

Select the relevant information required:

• I am interested in working in childcare:  
   
• I need further information on childcare qualification:  
   
• I am interested in registering as a childminder:  
   
• I am interested in setting up a day care service:  

To help us ensure fair and equal opportunities for all, please take some time to describe your ethnic origin.

Which of the following best describes your Ethnic origin? These categories are based on the 2001 census. Your answer must be within this list:

• White: British / Irish / Other (please specify)
• Mixed: White & Black Caribbean / White & Black African / White & Asian / Other Mixed Group (please specify)
• Asian or Asian British: Indian / Bangladeshi / Pakistani / Other Asian (please specify)
• Black or Black British: Caribbean / African / Other Black background (please specify)
• Chinese / Any other ethnic group

My ethnic origin is:

Are you disabled?    No        Yes  

Are You Lone Parent?    No        Yes  

Where did you find out about the site?:

Outdoor Advert        Bus Shelter or Tram        From a Friend        Search Engine  

Publication  

Other