Ludwick Nursery Application Form

Ludwick Nursery Application Form

Together we are building a better tomorrow
Are you applying for a place at: *

Ludwick Nursery (3-4 year olds) Tree Tops (2 year olds)
Please supply your 2 year old funding code if you have one. If you've not applied for your code you will need to provide one prior to you child starting with us
Child's Details
Child's name *

First Name Middle Name Last Name
Gender *

Male Female
Address *

Street Address

Street Address Line 2

City County

Postcode
Telephone number *
Child's date of birth *

Day Month Year
Child's age *
NHS number *
Parent(s)/Person(s) with Parental Responsibility
Parent/Carer 1
Name *

First Name Last Name
Relationship to child *
Telephone number *
Do you live at the same address as your child? *

Yes No
Address *

Street Address

Street Address Line 2

City State / Province

Postcode
Email address *
Date of birth *

Day Month Year
NI number *
Parent/Carer 2
Name

First Name Last Name
Relationship to child
Telephone number
Do you live at the same address as your child? *

Yes No
Address *

Street Address

Street Address Line 2

City County

Postcode
Email address
Date of birth

Day Month Year
NI number
Emergency Contacts
Contact 1
Contact 1 Name *

First Name Last Name
Address

Street Address

Street Address Line 2

City County

Postcode
Relationship to Child *
Telephone number *
Contact 2
Contact 2 Name

First Name Last Name
Address

Street Address

Street Address Line 2

City County

Postcode
Relationship to Child *
Telephone number *
Password

Please provide us with a password (one word only) to be used if your child is collected by anyone other than you
Password *
Sibling Details

Please list any other children in the family and their relationship to your child
Child 1:
Child 2:
Child 3:
Language, Religion & Ethic Origin
Is English your child's first language? *

Yes No
Other languages spoken in the home *
Family religion *
Example: None, Buddhist, Christian, Hindu, Jewish, Muslim, Sikh etc.
Religious implications for the school eg food, festival, clothing
Please specify
Ethnicity *
School Outings
Occasionally we will take the children out of school (for example, on a short walk to the local shop, a visit to the local Primary School to watch a play, or on a bus ride). We need permission before we are able to do this:

Visits: Please indicate below whether you are ALLOWING your child to be taken on short outings with staff. If you do not do this we will not take your child out of the nursery on school outings.
I agree to my child being taken on short outings *

Yes No
Mode of Travel
Please indicate how you will be travelling to nursery *

Walk Car Public transport Taxi Bike Scooter
Pre-Nursery Experience
Where did they attend?
How often did they go?
What age did they start?
Pre-nursery contact name and number
Other Professionals

Health Visitor, Speech & Language Therapist, Social Worker etc.
Professional 1
Professional 2
Medical
Doctor's name

First Name Last Name
Medical practice *
Address *

Street Address

Street Address Line 2

City County

Postcode
Telephone number *
Does your child have any medical conditions *

Allergies Medical conditions Special dietary needs Other conditions/needs None
Please provide details of medical conditions *
Will your child need special help from a member of staff? *

Yes No
Detail any special help needed *
Disability Living Allowance (DLA)
Disability Living Allowance (DLA) for children may help with the extra costs of looking after a child who:
- is under 16 years old
- has difficulties walking or needs much more looking after than a child of the same age who does not have a disability
They will need to meet all the eligibility requirements.

Usually, to qualify for Disability Living Allowance (DLA) for children the child must:
- be under 16
- need extra looking after or have walking difﬁculties
- be in England, Wales, a European Economic Area (EEA) country or Switzerland when you claim - there are some exceptions, such as family members of the Armed Forces
- have lived in Great Britain for at least 6 of the last 12 months, if over 3 years old
Are you in receipt of disability living allowance? Please provide proof if requested. *

Yes No
Immunisations
Is your child up to date with their immunisations? *

Yes No
Other information
Please detail below any other information about your child you feel we should be aware of.
Nursery Sessions
Nursery sessions are held either in the morning or in the afternoon, Monday to Friday, during term time. Please state your preference, if you have one, and explain the reason for your choice.

Morning sessions begin at 9.00am and finish at 12.00. Afternoon sessions begin at 12.30pm and finish at 3.30pm.
How many hours would you like? *

15 hours 30 hours
Which session would you prefer? *

Morning Afternoon No preference
Please give your reason
Parents must apply online at www.childcarechoices.gov.uk to obtain an eligibility code before a 30 hour place can be confirmed.
Are you eligible for a 30 hour place? *

Yes No
Do you wish your child to have a 30 hour place at Ludwick Nursery School *

Yes No
30 hour eligibilty code
Photo Consent
Occasionally we take photographs and/or video footage of the children at school. We may use these images in various ways including newsletters, digital displays, publications, websites etc. Sometimes the media may visit the Centre and take photographs or film the children. They may use these images in newspaper articles, websites or printed publications. Images will be stored by the Centre, other centres or the media in archives and may be used up to two years later, after which the images will be destroyed. To comply with the Data Protection Act 2018, we need permission from the child’s parent or guardian before we can photograph or make recordings of any child, or allow any visiting media to do so.

To give your consent, please tick the boxes below to clearly indicate in which areas you are happy for your child’s image to be used.

Conditions for use of images:

1. This consent is valid for the period of time your child attends Ludwick Nursery School. Images will not be used after this time.

2. The images taken will be of activities that show the children and the school in a positive light.

3. Embarrassing or distressing images will not be used.

4. We may use group or class photographs or footage with very general labels e.g. small group activity, sport day

5. We will only use images of children who are suitably dressed.

6. We will make every effort to ensure that images are not taken of children for whom permission has not be given, or who are ‘at risk’ or disallowed from being photographed for legal or social reasons.

7. We will take all reasonable measure to ensure the images are used solely for the purposes for which they are intended. However, we cannot guarantee this and take no responsibility for the way images are used by other websites or publishers or consequences arising from publication.
I give my permission for my child's image to be used for the purposes as mentioned above *

Yes No
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 this policy. By ticking the box below you agree to us contacting you my email.
I have read and agree with the Privacy Notice for Parents/Carers *

Yes
DECLARATION

The information I have given on this form is accurate and correct to the best of my knowledge.

I understand that my personal information will be held securely and will be used only for local authority purposes.

I agree to Ludwick Nursery School using this information to consider my application for a nursery place.

I understand that the completion of an application form does not guarantee a place in the nursery class.
I agree with the declaration above *

Yes
Notes to parent

How the information on this form will be used:

By completing this form and signing the declaration you are agreeing for Ludwick Nursery School, if they are oversubscribed, to check whether your child’s details meet the school’s published admissions rules and if he/she can be offered a nursery place.

Any personal data collected will be treated as confidential under the principles of the Data Protection Act 2018. We will not use the data for any other purpose, nor will we share your data with any third parties other than the Department for Education (for statutory reporting), Hertfordshire County Council departments who may from time to time send you advise, guidance and information relating to changes to early years provision and educational services that are relevant and/or of benefit to your child and your local children’s centre who support the local authority by assisting families to access the services that children are entitled to.
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Ludwick Nursery Application Form

Child's Details

Parent(s)/Person(s) with Parental Responsibility

Parent/Carer 1

Parent/Carer 2

Emergency Contacts

Contact 1

Contact 2

Password

Sibling Details

Language, Religion & Ethic Origin

School Outings

Mode of Travel

Pre-Nursery Experience

Other Professionals

Medical

Disability Living Allowance (DLA)

Immunisations

Nursery Sessions

Photo Consent

DECLARATION

Notes to parent