Childcare Provider Registration Please complete the short form below and one of our team will be back in touch soon. If you have any questions or would rather complete this form over the phone please call us on 01280 851113 YOUR DETAILS First Name * Last Name * Email * Organisation Name Address * Postcode Telephone Type of Childcare Provision Childminder Day Nursery Out of hours school club Holiday Club Play Scheme Nanny Other (please specify)Other (please specify) Registration No. * Ofsted or equivalent PAYMENT DETAILS Bank Name Account Name * Account No. * Sort Code * Your Reference How you would like payments referenced for your records YOUR AGREEMENT * I confirm that I give Gemelli permission to contact me in relation to this enquiry using the details provided. DATA PROTECTION The information that you provide on this form will be used in a confidential manner to help us process your request. We abide by the Data Protection Act and General Data Protection Regulations. We are conscious of only taking the personal data from you that we require and will keep it safe and secure. Please confirm you understand and agree to this Data Protection Statement and that we need to take details about you to process this application. You can find details of how we process your personal data in our Privacy Policy on our website. * I confirm I understand and agree with this Data Protection Statement. SUBMIT YOUR REQUEST Please now submit your request by clicking on the button below. One of our team will be in touch shortly – thank you. Captcha If you are human, leave this field blank. Submit
