Brookland Infant and Nursery School

Brookland Infant and Nursery School

Early Years Application Form
The closing date for applications for starting nursery in September 2023 is midday on Wednesday 8th March 2023 for children born between 1st September 2019 and 31st August 2020.

You will need to bring your original birth certificate into school after completing this form to verify date of birth. Evidence is also required for children 'At Risk' or with a medical or social reason to go to this school.
Child's Details
Name *

First Name Middle Name Surname
Date of Birth *

Day Month Year
Gender *

Male Female
NHS Number *
Child's Address *

Street Address

Street Address Line 2

City County

Postcode
Special Educational Needs *

Yes No
At Risk *

Yes No
Children in Public Care *

Yes No
Social or Medical Reasons *

Yes No
If you have a sibling at this school, please enter their name and date of birth
Please give the name of the Early Years/Pre-School setting your child currently attends or has attended, of applicable
Sessions Required
Our provision offer currently is 15 hours free early education, taken as 5 mornings or 5 afternoons per week term time only.

We also offer a limited number of 30 hour places. Priority is given to parents are eligible under the government scheme.

Please indicate your preference below.
Preferred session *

15 hours, mornings (8.45 - 11.45am) 15 hours, afternoons (12.30 - 3.30pm) 15 hours, no preference 30 hours (8.45am - 3.30pm Mon to Thurs, 8.45 - 11.45am Fri)
Please provide a reason for your choice *
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).

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.

Parents will have the option of paying for extra hours if they wish their child to stay until 3.30pm on Fridays.
HMRC code if available
Parent/Carer Details
Name *

Title Forename Surname
Relationship to Child *
National Insurance Number *
Address *

Street Address

Street Address Line 2

City County

Postcode
Email *
Telephone Number *
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 school/local authority purposes.
- I agree to Brookland Infant and Nursery School using this information to consider my application for a nursery place. 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 class.
- I understand that, if offered a place in the nursery class, I will have to apply separately for a place in reception.
- I understand that, if offered and I accept a place in the nursery class, I will be required to pay a deposit of £50 which will be returned to me when my child transfers to a reception class
- I understand that, if offered and I accept a place in the nursery class, I have to accept that nursery staff will arrange to visit myself and my child in our home.
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.

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.
I have read and agree with the declarations above *

Yes
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Brookland Infant and Nursery School

Child's Details

Sessions Required

30 Hours Entitlement

Parent/Carer Details

Declaration

Data Protection