Arlesdene Nursery School Admissions Form

Arlesdene Nursery School Admissions Form

September 2023 Intake Opens at 2pm Friday 6th January 2023. Applications before this time will not be held on the system.
Information on our admissions criteria can be found at: http://arlesdene.herts.sch.uk/about-us/admissions/

For further information or any queries please email office@arlesdene.herts.sch.uk
1. About your Child
Please note: Applications open at 2pm on Friday 6th January 2023.

We will accepting Nursery applications for children born between 1st September 2019 and 31st August 2020. If your child falls outside this date range please email office@arlesdene.herts.sch.uk
Child's Name*

First nameMiddle nameFamily name
Gender*

MaleFemale
Date of birth*

DayMonthYear
Address*

Street Address

Street Address Line 2

CityCounty

Postcode
Home/mobile number
Previous setting attended*

ChildminderDay NurseryArlesdene Pre-schoolOtherNone
Name of setting*
Telephone number of setting*
Sibling/s at Arlesdene
Does your child have a sibling at Arlesdene Nursery School?*

YesNo
Sibling's Name*

First NameLast Name
2. Parents/Carers Contacts Details
Parent/Carer 1
Name*

TitleFirst NameLast Name
Relationship to the Child*
eg Mother/Father/Carer/Stepmother/Father/Social Worker
Parental responsibility*

YesNo
Date of birth*

DayMonthYear
Is your address the same as the child's?*

YesNo
Address*

Street Address

Street Address Line 2

CityCounty

Postcode
Email address*
Mobile number*
Work number
Employer/Role
Parent/Carer 2
Name

TitleFirst NameLast Name
Relationship to the Child
eg Mother/Father/Carer/Stepmother/Father/Social Worker
Parental responsibility

YesNo
Date of birth

DayMonthYear
Is your address the same as the child's?

YesNo
Address

Street Address

Street Address Line 2

CityCounty

Postcode
Email address
Mobile number
Work number
Employer/Role
Other authorised person for collection
3. Sessions Required
15 Hours Entitlement

Please note that all Nursery sessions run Monday to Friday inclusive. We do not offer part week or a combination of morning and afternoon sessions due to the manner in which the curriculum is delivered.

30 Hours Entitlement

If both parents/single parents are working more than 16 hours at minimum wage (or equivalent) your child may be entitled to 30 hours free child care (including 15 hours education).

Parents must apply online at www.childcarechoices.gov.uk to obtain an eligibility code before a 30 hour place can be confirmed. Applications can be made as early as 16 weeks before your child’s third birthday.
Session times*

Mornings (8.45 - 11.45am)Afternoons (12.30 - 3.30pm)30 hours (8.45am - 3.30pm)
HMRC code
If you have already applied and obtained your HMRC code, please enter it here
Parent/Carer 1 NI Number*
Parent/Carer 2 NI Number
I confirm that I am eligible for the 30 hour offer and will apply at the earliest date possible. I will provide the 30 hour code once received and understand that any offer of a 30 hour place is conditional upon this requirement. Failure to comply may result in the offer being withdrawn.*
4. Medical Information
My child's NHS number*
Doctor's surgery name*
Address*

Street Address

Street Address Line 2

CityCounty

Postcode
Tel no.*
Name of Health Visitor
Has your child ever been stung by a bee or a wasp? *

YesNo
Please provide further details, including if they had a reaction and what treatment was given.*
Does your child have any medical conditions including allergies?*

YesNo
Condition/Allergy*
Treatment*
Details of any medication taken regularly by your child
In the event your child has an accident or is taken seriously ill at school you give permission for staff at Arlesdene to seek further medical advice or treatment which may include receiving life saving treatment.I.E. Defribillator, Epi Pen & Inhaler. If the school are unable to contact any of the emergency contacts and an ambulance is not available. The Headteacher or Teacher in charge will drive your child to the nearest medical centre. We are insured to do so and will have the appropriate car seat for your child to travel in. In an emergency we will always do our best to contact parents or carers.*

YesNo
5. Dietary Needs
Does your child have any special dietary needs?*

YesNo
Special dietary needs*

VegetarianReligious/culturalMedically diagnosed food allergy
Details including date medical diagnosis obtained if relevant*
6. Special Educational Needs & Social Care
Does your child have an Education, Health & Care Plan or an Individual Education Plan?*

YesNo
Is your child or a sibling of your child the subject of an inter-agency child protection plan and has been placed on the Child Protection Register?*

YesNo
Is your child looked after, or has previously been looked after?*

YesNo
Is your child adopted or under special guardianship?*

YesNo
Are there any social or medical concerns?*

YesNo
Are there any other professionals involved with your child?*

YesNo
Details of professionals*
7. Ethnicity & Culture

Please tick one box below to indicate the ethnic background of your child
White

BritishIrishTraveller from Irish HeritageGypsy/RomaItalianTurkishTurkish CypriotAny other White background
Mixed

White & Black CaribbeanWhite & Black AfricanWhite & AsianAny other mixed background
Asian or Asian British

IndianPakistaniBangladeshiChineseAny other Asian background
Black or Black British

CaribbeanAfricanAny other Background
I do not wish an ethnic background recorded

Yes
First language of child*

English
Religion

ChristianMuslimSikhBuddhistJewishHinduNo Religion
I do not wish to record a religion

Yes
8. Service Child in Education
Has either parent served in the Armed Forces?*

YesNo
Date from*

DayMonthYear
Date to*

DayMonthYear
9. Use of Images
While your child is at Arlesdene we would like to take photographs or video of them in order to capture their learning and their experiences. These are included on their learning story which will be available for you to see at Arlesdene and electronically. We also sometimes use children’s photographs in displays, literature, staff training, our website and Facebook page and occasionally for the local newspaper. We would like your permission to use photographs or film of your child in this way.

To comply with the GDPR 2018 and current Data Protection Act, we need your permission before we can photograph or make any recordings of your child. Please answer the questions below, then sign and date the form where indicated.

I give permission for my child to be photographed and filmed on video for:
My child's learning journal, annual group & individual photos, and nursery displays*

YesNo
In the Nursery's publications, on our website, Facebook and press articles. Children's names are never used.*

YesNo
Please note that websites can be viewed throughout the world and not just in the United Kingdom where UK law applies.

Conditions of use
- Please contact Arlesdene at any time if you wish to withdraw your consent.
- We will not use the personal details or full names (which means first name and surname) of any child or adult in a photographic image on video, on our website, in our documentation or in any of our other printed publications.
- We will not include personal e-mail or postal addresses, or telephone or fax numbers on video, on our website, in our documentation or in other printed publications.
- If we use photographs of individual pupils, we may use the first name of that child in the accompanying text or photo caption within the school or for training purposes, but not in any media publications.
- Photos used within the school for display may be accompanied by the child’s first name, describing what s/he is doing.
- We may use group or class photographs or footage with very general labels, such as “making Christmas decorations”.
10. Additional Information
I am willing for my child to join outings organised by the School e.g. a short walk, visit to local shops.*

YesNo
We use a service called Arbor to send messages by email and text. I give consent for Arlesdene to register my email address and mobile number with Arbor*

YesNo
Data Protection

In accordance with General Data Protection Regulation and current Data Protection Act, the school has a duty to protect this information and to keep it up to date. The school is required to share some of the data with the Local Authority and with the DfE.

Privacy Notice

In completing this application form you should refer to our Privacy Notice for Parents/Carers. The personal information collected on this form will be processed to manage your application in accordance with our Data Protection Policy.
I confirm that the details above are correct to the best of my knowledge*

Yes
I have read and agree with our Parent Privacy Policy*

Yes
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Arlesdene Nursery School Admissions Form

1. About your Child

2. Parents/Carers Contacts Details

3. Sessions Required

4. Medical Information

5. Dietary Needs

6. Special Educational Needs & Social Care

7. Ethnicity & Culture

8. Service Child in Education

9. Use of Images

10. Additional Information