Nursery Application Form

Name*

First NameMiddle NameFamily Name

Date of Birth*

DayMonthYear

Gender*

MaleFemale

NHS Number*

Your relationship to the child*

eg mother/father/carer/stepmother/stepfather/social worker

Your child's permanent address (at time of application)

Street address*

Town/City*

County*

Postcode*

Special Educational Needs*

YesNo

At risk*

YesNo

Children in Public Care or children who have been adopted*

YesNo

Social or medical reasons*

YesNo

If you have ticked Yes to any of the above, please enter further information here.

If you have a sibling at this school, enter their name and date of birth:

1st sibling

2nd sibling

Please enter the name and contact details of your child's current childcare provider.*

The pattern of attendance can be a combination of any of the morning and/or lunch and/or afternoon sessions, on any of the school days in a week. Children staying over lunchtime can bring a packed lunch from home or you can pay for a school meal.

Please note that your child must attend for the whole session (3 hours) and can only stay for lunch on days when they are attending a session. We do operate a flexible drop off between 8.30am and 9.00am and pick up between 3.00pm and 3.30pm to enable you to pick up and drop off children in the main school.

Session times are:

AM (8.30 am – 11.30 am)
Lunch (11.30 am – 12.30 pm)
PM (12.30 pm – 3.30 pm)

Everyone is entitled to 15 hours free provision and some families are entitled to 30 hours free provision. For more details see www.childcarechoices.gov.uk.

If you would like more than 15 hours for your child but are not eligible for the 30 hours funding, you can request the additional hours which are currently charged at £4.30 per hour. The charge per hour is reviewed and increased in line with inflation annually in September.

Please select the days you would like your child to attend:

	Monday	Tuesday	Wednesday	Thursday	Friday
AM
Lunch
PM

Total number of hours selected

If you have any other requirements, please enter here:

Parent/Carer 1

Name*

TitleFirst NameLast Name

Address if different from child's

Street address

Town/City

County

Postcode

Email address*

example@example.com

Telephone number*

If you work at this school please enter your job title:

Is there another parent who has parental responsibility?*

YesNo

Parent/Carer 2

Name*

TitleFirst NameLast Name

Address if different from child's

Street address

Town/City

County

Postcode

Email address*

example@example.com

Telephone number*

If you work at this school please enter your job title:

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

I have completed all of the above information as requested and confirm that the information provided is true and accurate.*

Yes

Parent Signature

Nursery Application

Child's Details

Sessions

Parent/Carer details

Parent/Carer 1

Parent/Carer 2

Data Protection