Greenfield Nursery & Pre-School Admissions Form

Greenfield Nursery & Pre-School Admissions Form
Information on our admissions criteria can be found at: http://greenfieldnursery.co.uk/nursery/applying-for-primary-nursery-and-pre-school

For further information or any queries please call 01992 760779
1. About your Child
Child's Name*

First nameMiddle nameFamily name
Sex at Birth*

MaleFemale
Date of birth*

DayMonthYear
NHS no.*
Address*

Street Address

Street Address Line 2

CityCounty

Postcode
Local Authority:- What Local Authority do you pay your Council Tax to?*
Previous setting attended*

Greenfield Pre-schoolOther SettingNone
If your child has attended another setting please complete. I give permission for you to contact my previous setting with regards to my child starting at Greenfield*

YesNoN/A
Name of setting or N/A*
Telephone Number or N/A*
Address of setting or N/A*
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
Parent authorised to collect?*

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

YesNo
Address*

Street Address

Street Address Line 2

CityCounty

Postcode
Email address*
Mobile/Home number*
Work number
National Insurance no.*
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
National Insurance no.
Parent authorised to collect?

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

YesNo
Address

Street Address

Street Address Line 2

CityCounty

Postcode
Email address
Mobile/Home number
Work number
Emergency Contact details who is authorised to collect (not the parent).*
Emergency Contact details who is authorised to collect (not the parent)
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). Please speak to the school office regarding the 30 hour timetable.

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.

Additional Provisions

Breakfast Club

We offer Breakfast Club Monday to Friday which is booked via the office and is a chargeable session which includes a choice of cereal, fruit or toast.

30 hours

Our 30 hour provision:

Monday to Thursday 8.40am to 3.25pm (27 hours) & Friday 8.40 to 11.40 (3 hours)

If you would like your child to stay for lunch and/or the afternoon session on a Friday this is chargeable and you are able to book via the office.

Please note the above is subject to change.
Do you receive any benefits*

YesNo
Session times*

Mornings (8.40 - 11.40am)Afternoons (12.30 - 3.30pm)30 hours (Monday to Thursday All day/ Friday until 11.30) Friday afternoons are chargeable. Please contact the office with regards to booking and fees.Breakfast Club (8.00- 8.40am) Please contact the office with regards to booking and fees.
HMRC Code
If you have already obtained your code from the HMRC please insert in the above box.
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.*

YesNo
4. Medical Information
Doctor's surgery name*
Address*

Street Address

Street Address Line 2

CityCounty

Postcode
Tel no.*
Name of Health Visitor*
Does your child have any medical conditions including allergies?*

YesNo
Condition/Allergy*
Has your child been immunised against?

DiptheriaWhooping coughTetanusPoliomyelitisMMR
In the event of an emergency and the school is unable to contact any of the emergency contacts listed above, I give permission for my child to be accompanied by a member of staff and taken to hospital in an ambulance. If necessary I give permission for my child to be X rayed.*

YesNo
I give consent for a member of staff to apply sun cream*

YesNo
I give consent for a member of staff to change my child clothes/nappy*

YesNo
I give consent for face paints to be used on my child*

YesNo
I give consent for Calpol to be administered if necessary*

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
Does your child have any special educational needs or disabilities that we need to know of?*

YesNo
Further details*
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 in the care of/or previously been in the care of the Local Authority (looked after child)?*

YesNo
Is your child adopted or under special guardianship?*

YesNo
Are there any social or medical educational concerns?*

YesNo
Are there any other professionals involved with your child? (Social Worker, Family Worker, Medical Teams, Solicitor, etc)*

YesNo
Details of professionals*
Details of professionals
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 Black Background
I do not wish an ethnic background recorded
First language of child*

EnglishOther
Home language of child*

EnglishOther
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/Consent of Images
While your child is at Greenfield we would like to take photographs or video of them in order to capture their learning and their experiences. These are included on their online learning journals through the app. 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 or filmed on video for use:
In my child's online learning journal*

YesNo
In the Federation Newsletter*

YesNo
Within a group photo activity*

YesNo
For displays of learning and experiences in and around the school building*

YesNo
In individual/group photos by the school photographer*

YesNo
On our website*

YesNo
On our Facebook page*

YesNo
In an article in the press*

YesNo
10. Additional Information
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 Greenfield 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 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”.
I am willing for my child to join outings organised by the School e.g. a short walk, visit to local shops without prior notice to parents*

YesNo
We use a service called Learning Journals to communicate children's learning. I give consent for Greenfield to register my email address to activate a parent account.*

YesNo
We communicate through our management system Arbor to send messages by email and text. I give consent for Greenfield to register my email address and mobile number with Arbor.*

YesNo
I give permission for Greenfield staff to contact professionals about my child if necessary. If we have any concerns about your child we will talk to you*

YesNo
Does your child have a younger sibling?*

YesNo
Sibling's Name*
Sibling's Date of Birth*

DayMonthYear
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.

Data Protection Policy

Please also read the following.

Admissions Policy

Charging and Remissions Policy
I have read and agree with our parent Privacy Notice, Data Protection Policy, Admission Policy and Charging and Remission Policy*

Yes
I confirm that the details above are correct to the best of my knowledge*

Yes
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
This is a fill in the blanks field. Please add appropriate blank fields and text.
Phone Number

Area CodePhone Number
This is a fill in the blanks field. Please add appropriate blank fields and text.
Should be Empty:

Greenfield Nursery & Pre-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/Consent of Images

10. Additional Information