Nursery admissions form.Please complete this form for mursery places and we will be in touch. Parent or carer's name * First Name Last Name Email of parent or carer * Child's gender * Female Male Rather not say Child's date of birth * MM DD YYYY Verification method * Birth certificate Utility bill / other Evidence to support financial implications/NI number Child's name * First Name Last Name Known to family as: Address where child resides Address 1 Address 2 City State/Province Zip/Postal Code Country Child's prime carer's name * First Name Last Name Child's prime carer's name * First Name Last Name Prime carer's relationship to child * Phone number of prime carer * (###) ### #### Permanent address of prime carer Address 1 Address 2 City State/Province Zip/Postal Code Country Second carer's name First Name Last Name Relationship to child of second carer Email of second carer Phone number of second carer (###) ### #### Permanent address of second carer Address 1 Address 2 City State/Province Zip/Postal Code Country Child's religion Child's first language * Does your child stay with a child minder? * Yes No Has your child had any previous nursery experience? * Yes No If so please state name of playgroup, toddler group etc. * Have you applied for a Foundation 1 place anywhere else? * Yes No If so please give details: * Medical Information: (e.g. allergies, asthma, speech therapy, regular medication) Name of child's medical practice (doctor's surgery) * Address of child's medical practice * Address 1 Address 2 City State/Province Zip/Postal Code Country Additional information to support your application. i.e. if your child has any special education needs identified through statutory assessment. Please let us know below if you receive any income support, income based job seekers allowance, disability allowance or working tax credit. (in the instance of being oversubscribed we may need to ask for evidence of the above Please show if you have a preference for session: 30 Hour Funded Morning (8.50–11.50am) Afternoon (12.20–3:20pm) Monday & Tuesday full day, Wed. am Wed. pm, Thursday & Friday full day When offering a place we will, where possible, take this into consideration but we are unable to guarantee your preference. * When offering a place we will, where possible, take this into consideration but we are unable to guarantee your preference. 30 Hour Funded Morning (8.50–11.50am) Afternoon (12.20–3:20pm) Monday & Tuesday full day, Wed. am Wed. pm, Thursday & Friday full day Thank you, we will be in touch. Data protection policies
