Child's Surname *
Child's Forename *
Sex * —Please choose an option—BoyGirl
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
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.
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