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 nameMiddle nameLast name
Child's preferred name
Gender*

MaleFemale
Date of birth*

DDMMYYYY
Address*

Street Address

Street Address Line 2

CityCounty

Post code
Was your child born early, before 37 weeks?*

YesNo
Please add details
Previous setting attended*

YesNo
Name of setting*
Address

Street Address

Street Address Line 2

CityCounty

Postcode
Attended from:*

DDMMYYYY
Attended to:*

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

YesNo
Other children in family
Are there other children in the family?*

YesNo
Name

First NameLast Name
Date of birth

DDMMYYYY
School attended
Add another child

YesNo
Name

First NameLast Name
Date of birth

DDMMYYYY
School attended
Add another child

YesNo
Name

First NameLast Name
Date of birth

DDMMYYYY
School attended
Add another child

YesNo
Name

First NameLast Name
Date of birth

DDMMYYYY
School attended
Add another child

YesNo
Name

First NameLast Name
Date of birth

DDMMYYYY
School attended
Add another child

YesNo
Name

First NameLast Name
Date of birth

DDMMYYYY
School attended
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
Date of birth*

DDMMYYYY
National Insurance Number*
Is your address the same as your child's?*

YesNo
Address*

Street Address

Street Address Line 2

CityCounty

Postcode
Postcode*
Email address*
Telephone number*
Work number
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

DDMMYYYY
National Insurance Number
Is your address the same as your child's?

YesNo
Address

Street Address

Street Address Line 2

CityCounty

Postcode
Postcode
Email address
Telephone number
Work number
Is there anyone else with parental responsibility*

YesNo
Name

First NameLast Name
Date of birth

MonthDayYear
Date
Relationship to child
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*
Sessions Required

For all funded places please apply for funding online at www.childcarechoices.gov.uk to obtain an eligibility code.
Which sort of place are you applying for?*

Fee paying2 year funded2 year funded (working families)3/4 year funded
Funding code
Preferred sessions- Please tell us your preferred days/hours e.g. 15 hours AM or PM, 30 hours. *Please note what we can offer will depend on what is available at the time
Medical Information
My child's NHS number*
Doctor's surgery name*
Address

Street Address

Street Address Line 2

CityCounty

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

YesNo
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.*

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

YesNo
Special dietary needs*

VegetarianReligious/culturalMedically diagnosed food allergyVeganOther
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?*

YesNo
Please add details. When was the plan issued? When your child starts at Rye Park please share the plan with staff/SENCO.
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
Has your child previously been known to a Social Worker?*

YesNo
Please add further details including in what capacity.
Are there any social or medical concerns?*

YesNo
Please can you detail any concerns
Are there any other professionals involved with your child?*

YesNo
Details of professionals*
Do you have concerns about your child's development?*

YesNo
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*
Main language spoken at home*
Other languages spoken at home
Religion

ChristianMuslimSikhBuddhistJewishHinduNo ReligionOther
I do not wish to record a religion

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

YesNo
Which parent?

First NameLast Name
Date from*

DDMMYYYY
Date to*

DDMMYYYY
Child Collection Password

I give permission, for anyone (over the age of 16 years) who gives the password to Rye Park Nursery Staff, to hand over my child to his or her care. Please ensure you ring to let us know that a different adult is collecting your child. If you wish to change your password please speak to office staff.
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 Tapestry accounts, an online app for sharing learning, success and special events, which you will be linked to.

We may also share class learning regularly through spotlights and newsletters.

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 2018, we need your permission before we can photograph or make any recordings of your child. Please answer the questions below.

I give permission for my child to be photographed and filmed on video for:
Their individual Tapestry account*

YesNo
Within a group photo, shared on Tapestry*

YesNo
Within a group video, shared on Tapestry.*

YesNo
Displays of learning and experiences within the school*

YesNo
Within the monthly newsletters sent to all families and published on the website.*

YesNo
In the Nursery's publications produced for promotional purposes including school brochure and website*

YesNo
An article in the press*

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 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*

YesNo
I give consent for child's own sun cream to be applied when necessary*

YesNo
I give consent for baby wipes to be used*

YesNo
I give permission for my child to be used anonymously in student coursework*

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

Parent Privacy Notice

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 Rye Park Nursery School's 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 and phone numbers provided for communication.
I agree with the declaration above*

Yes
Should be Empty:

Rye Park Nursery School

Nursery Admissions Form

About your Child

Parents/Carers/Contacts

Sessions Required

Medical Information

Dietary Needs

Special Educational Needs & Social Care

Ethnicity & Culture

Service Child in Education

Child Collection Password

Use of Images

Additional Information

Declaration