Application Form

Child's Surname *

Child's Forename *

DOB-Day *
—Please choose an option—12345678910111213141516171819202122232425262728293031

Month *
—Please choose an option—JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember

Year *
—Please choose an option—2009201020112012201320142015201620172018201920202021202220232024

Address *

Postcode *

Name *

Mobile No *

Work No *

Place of Work/Employer/Department *

Home No *

Email *

Name

Mobile No

Work No

Place of Work/Employer/Department

Home No

Email

Day
—Please choose an option—12345678910111213141516171819202122232425262728293031

Month *
—Please choose an option—JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember

Year *
—Please choose an option—202020212022202320242025

Monday
AMLunchPM

Tuesday
AMLunchPM

Wednesday
AMLunchPM

Thursday
AMLunchPM

Friday
AMLunchPM

Monday
AMPM

Tuesday
AMPM

Wednesday
AMPM

Thursday
AMPM

Friday
AMPM

If your child will be attending the 'Kid's Club' will you require use of the school bus? *
YesNo

If so, which primary school do/will they attend?

Will you require care in the Kid's Club for half term time only? *

Does your child currently attend another setting? *
YesNo

Lorna Barker (MA DIP SW) is our Special Educational Needs Co-ordinator. In accordance to our Equal Opportunities policy we aim to develop inclusive practice within our setting, it may be necessary to seek advice from other professionals from time to time on how to adopt our practice to meet individual needs. Please sign to acknowledge agreement with this.

Does your child have any allergies? *

Does your child suffer from any medical conditions? *

Has or is your child currently seeing any of the following professionals:
Health VisitorAdvisory TeacherSpeech and Language TherapistPortageEducational PsychologistOccupational TherapistPaediatricianPhysiotherapist

Other

If you answered yes to any of the above please give details

Are you entitled to any 2 year old government funding? *
YesNo

ANY INFORMATION GIVEN WILL BE USED FOR THE SOLE USE OF THE NURSERY.
ALL INFORMATION WILL REMAIN STRICTLY CONFIDENTIAL.

Where did you hear about the nursery? *

Have you visited the nursery? *
YesNo

AFTER RECEIVING YOUR APPLICATION, IT WILL BE PLACED ON THE WAITING LIST. ONCE A PLACE BECOMES AVAILABLE WE WILL CONTACT YOU AND INVITE YOU IN TO HAVE A LOOK AROUND AND MEET THE STAFF.