Rye Park Nursery School Admissions Form

Rye Park Nursery School
Nursery Admissions Form
For further information or any queries please email admin@ryepark.herts.sch.uk
About your Child
Child's legal name *

First name Middle name Last name
Child's preferred name
Gender *

Male Female
Date of birth *

DD MM YYYY
Was your child born early, before 37 weeks? *

Yes No
Please add details
Address *

Street Address

Street Address Line 2

City County
Postcode *
Previous setting attended *

Childminder Day Nursery Preschool/playgroup Other None
Name of setting *
Address *

Street Address

Street Address Line 2

City County

Postcode
Attended from: *

DD MM YYYY
Attended to: *

DD MM YYYY
I give permission for Rye Park nursery to contact and receive information from my previous setting or my next setting.

Yes No
Tell us why you have said no.
Other children in family
Are there other children in the family?

Yes No
Name

First Name Last Name
Date of birth

DD MM YYYY
School attended
Add another child

Yes No
Name

First Name Last Name
Date of birth

DD MM YYYY
School attended
Add another child

Yes No
Add another child

Yes No
Add another child

Yes No
Add another child

Yes No
Name

First Name Last Name
Date of birth

DD MM YYYY
School attended
Parents/Carers/Contacts
Parent/Carer 1
Name *

Title First Name Last Name
Relationship to the Child *
eg Mother/Father/Carer/Stepmother/Father/Social Worker
Parental responsibility *

Yes No
Date of birth *

DD MM YYYY
National Insurance Number *
Is your address the same as your child's? *

Yes No
Address *

Street Address

Street Address Line 2

City County
Postcode *
Email address *
Telephone number *
Work number
Is there another parent who has parental responsibility? *

Yes No
Parent/Carer 2
Name *

Title First Name Last Name
Relationship to the Child *
eg Mother/Father/Carer/Stepmother/Father/Social Worker
Parental responsibility *

Yes No
Date of birth *

DD MM YYYY
National Insurance Number *
Is your address the same as your child's? *

Yes No
Address *

Street Address

Street Address Line 2

City County
Postcode *
Email address *
Telephone number *
Work number
In the event that we are unable to contact you, please provide in priority order the names of additional local people we can contact in an emergency:
Contact name 1 *
Contact name 2 *
Contact name 3
Sessions Required
Session times *

Mornings (8.45 - 11.45am) Afternoons (12.30 - 3.30pm) 30 hours (8.45-2.45pm)
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 is entitled to 30 hours free child care (including 15 hours education). The free hours will be from 8.45-2.45pm.

The late Slot from 2.45-3.30pm can be purchased separately. Please indicate below if you would like the additional time.
Late Slot *

Yes No
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.
HMRC code
If you have already applied and obtained your HMRC code, please enter it here
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 to Rye Park Nursery 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. *

Yes
Medical Information
My child's NHS number *
Doctor's surgery name *
Address

Street Address

Street Address Line 2

City County

Postcode
Telephone number *
Name of Health Visitor if known
Does your child have any medical conditions including allergies? *

Yes No
Condition/Allergy *
Treatment *
Details of any medication taken regularly by your child
Comments
In the event of an emergency and Rye Park Nursery School are 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 receive the appropriate medical treatment. *

Yes No
Please explain your reasons for saying no to the above consent
Dietary Needs
Does your child have any special dietary needs? *

Yes No
Special dietary needs *

Vegetarian Religious/cultural Medically diagnosed food allergy Vegan
Details including date medical diagnosis obtained if relevant *
Special Educational Needs & Social Care
Does your child have an Education, Health & Care Plan or an Individual Learning Plan? *

Yes No
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? *

Yes No
Is your child looked after, or has previously been looked after? *

Yes No
Is your child adopted or under special guardianship? *

Yes No
Are there any social or medical concerns? *

Yes No
Please can you detail any concerns
Are there any other professionals involved with your child? *

Yes No
Details of professionals *
Do you have concerns about your child's development? *

Yes No
Please detail your concerns *
eg. hearing, vision, speech or physical difficulties
Ethnicity & Culture

Please select below to indicate the ethnic background of your child
Ethnicity *
First language of child *

English
Religion

Christian Muslim Sikh Buddhist Jewish Hindu No Religion
I do not wish to record a religion

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

Yes No
Date from *

DD MM YYYY
Date to *

DD MM YYYY
Child Collection Password

I give the authority, for any adult (over the age of 16 years) who gives the password to Rye Park Staff, to hand over my child to his or her care. This password may be changed at any time. Please ensure you ring to let us know that a different adult is collecting your child.
Password *
Use of Images
While your child is at Rye Park, in order to capture their learning and their experiences, we would like to take photographs and video. These are included in their portfolios which will be shared with you throughout the year. We also share learning on a weekly basis, through class postcards. We us an online app, Marvellous Me, to share children's learning, success and special events.

We use children’s photographs in displays, literature, staff training, or the website and occasionally for the local newspaper.

To comply with the Data Protection Act 1998, 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:
Children's portfolios *

Yes No
Within a group photo, shared on Marvellous Me, the website and via postcards *

Yes No
Within a group video, shared on Marvellous Me. *

Yes No
Displays of learning and experiences within the school *

Yes No
In the Nursery's publications produced for promotional purposes including school brochure and website *

Yes No
An article in the press *

Yes No
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 Rye Park 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 or 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”.
Additional Information
I give consent for nappy/clothing to be changed by members of staff *

Yes No
I give consent for sun cream to be applied when necessary *

Yes No
I give consent for face paint to be applied as required *

Yes No
I give consent for baby wipes to be used *

Yes No
I am willing for my child to join outings organised by the Class Teacher or Nursery staff e.g. a short walk, visit to local shops. *

Yes No
I give permission for my child to be used anonymously in student coursework *

Yes No
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 for Parents

In completing this application form you should refer to our Privacy Notice for Parents. The personal information collected on this form will be processed to manage your application in accordance with this policy.
I have read and agree with our Parent Privacy Policy *

Yes
Declaration

The information I have given on this form is complete and accurate. I understand that my personal information will be held securely and will be used only for Local Authority and DfE purposes.

Rye Park Nursery School will use this information to consider my application for a nursery place for my child. I understand that if any part of this completed application form is found to be false the offer of a place will be withdrawn.

I understand that the completion of an application form does not guarantee a place in the nursery.

I authorise Rye Park Nursery School to use the email addresses provided for communication.
I agree with the declaration above *

Yes
Should be Empty: