Application Form

Child’s Details

We need some details about your child and family. We have a legal obligation to collect and process this information in Accordance with The Early Year Foundation Stage (Welfare requirements) Regulations 2012 and therefore we do not require your consent for the first section of this form. Where information to be supplied is voluntary or where we do need consent this is identified. The information provided will be kept in paper form and used for the purpose of maintaining appropriate contact.
TO CLAIM NURSERY EDUCATION FUNDING THE FIRST TERM AFTER YOUR CHILD’S 3RD BIRTHDAY WE ARE REQUIRED TO SEE THEIR ORIGINAL BIRTH CERTIFICATE

Allergies

Doctor

Vaccinations

Date of last Tetanus jab

Dietary Requirements

Medication Details

Special Needs

Information regarding Parent/s or Carer/s

Emergency Contact Details

Please provide the names and contact details of 2 people (other than parents/guardians) who we can contact in case of an emergency. Persons authorised to collect the child. This is any other adult who may collect your child in your absence. Authorised persons must be over 18 years of age.

Note: It is your responsibility to ensure these people are happy for us to contact them and to hold their details.

Collection Password

A password system operates in our setting. A secure password is required and should be used by emergency contacts and persons authorised to collect you child. Ideally this should be one word and something that is easy to remember. Please do not use obvious things such as middle names. The password is required from anyone collecting your child. If they do not have the password we will not release your child to them.

Days required (Please tick which sessions you require)

Monday
Tuesday
Wednesday
Thursday
Friday

Starting Date Required

Funding

View the Prospectus.
*Please Note: NO alterations can be made to this application form without the WRITTEN authorisation of the above signatories. We do not have the right to withhold information from either parent without written evidence of legal intervention.