Arlesdene Nursery School Admissions Form

Arlesdene Pre-school Admissions Form
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

pre-schooloffice@arlesdene.herts.sch.uk
Sessions required

We take children in Pre-school from the age of 2 years old. We ask for a minimum of two sessions per week to allow them to settle fully and benefit from being here.

There is an option to increase sessions, but this needs to be arranged with the Pre-school leader in advance. This can only be done termly and is dependent upon spaces available.

2-year-old Funded places

You may be eligible for two-year-old funding for your child's place, you can check here for more information https://www.gov.uk/help-with-childcare-costs/free-childcare-2-year-olds

Funding is only available from the term after your child's second birthday.

You can apply for two-year funding at https://www.hertfordshire.gov.uk/ufs/CSF_FEE_2YRCLAIM.eb?ebd=0&ebz=1_1611586677697 (or contact your local family centre)
Please provide a 2-Year-Old funding number
3-year-old Funded places

All children are entitled to 15 hours free childcare from the term after their third birthday. This is dependent upon availability of spaces and will need to be pre-arranged with the Pre-school Leader the term before.
Session Times and Charging

Mornings 8.45am - 11.45am £19.50 per session (3 hours)

Lunch Club £5.50 per session ( supplying own packed lunch)

Afternoons 12.30pm - 3.30pm £19.50 per session (3 hours)
1. About your Child

Sessions Required

	Monday	Tuesday	Wednesday	Thursday	Friday
Mornings 8.45am- 11.45am
Lunch Club
Afternoons 12.30pm - 3.30pm

I would like my child to start (date): please note this is not a guaranteed start date*
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*

Please state the name and address of any current or previous setting.None
Name of setting*
Address*

Street Address

Street Address Line 2

CityCounty

Postcode
Attended from:*

DayMonthYear
Attended to:*

DayMonthYear
Sibling/s at Arlesdene
Name

First NameLast Name
Date of birth

DayMonthYear
Add 2nd child

YesNo
Name

First NameLast Name
Date of birth

DayMonthYear
2. Parents/Carers Contacts
Parent/Carer 1
Name*

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

YesNo
Is there a court order in place*

YesNo
Date of birth*

DayMonthYear
National Insurance Number
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
Is there a court order in place

YesNo
Date of birth

DayMonthYear
National Insurance Number
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. 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
Does your child have any health or medical conditions including allergies?*

YesNo
Condition/Allergy*
Treatment*
Details of any medication taken regularly by your child
Comments
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. Defribrillator, 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
4. 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*
5. Special Educational Needs & Disabilities
Do you have any developmental concerns about your child.*

YesNo
Please provide additional Information *
Does your child have an Education, Health & Care Plan or an Individual Education Plan?*

YesNoIn the process
Please provide additional Information *
Are there any other professionals working with you to support your child, or to support your family ?*

YesNo
Please provide additional Information *
Details of professionals*
Is your child in receipt of DLA Disability Living Allowance ?*

YesNoIn the process
6. Social Care
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
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

IndianPakistaniBangladeshiAny other Asian background
Black or Black British

CaribbeanAfricanAny other BackgroundChineseAny other ethnic group
I do not wish an ethnic background recorded
First language of child*

EnglishOther
Does your child speak English*

YesNo
Does your child understand English*

YesNo
Does your child hear any other languages in your family ?*

YesNo
Religion

ChristianMuslimSikhBuddhistJewishHinduNo ReligionOther
I do not wish to record a religion
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 story, annual group & individual photos, and nursery displays.*

YesNo
In the School's publications, on our website, Facebook and in press article. 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
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
Have you or your family had any recent changes to your family life for example, new baby, moved house or home circumstances ?*

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 have read and agree with our Parent Privacy Policy*

YesNo
Should be Empty:

Arlesdene Pre-school Admissions Form

2. Parents/Carers Contacts

3. Medical Information

4. Dietary Needs

5. Special Educational Needs & Disabilities

6. Social Care

7. Ethnicity & Culture

8. Service Child in Education

9. Use of Images

10. Additional Information