School and Nursery Admissions

Child's Name

Address

Postcode

Telephone Number

Email

Child's Date of Birth

Name of Parent/Carer

Relationship to Child

Parent 1 National Insurance Number

Parent 1 Date of Birth

Parent 2 National Insurance Number

Parent 2 Date of Birth

Does your child have a Statement of Special Educational Needs or will they require additional support in Nursery? If so, please provide details below:

Provision Provision 2 Year Old Provision 3 Year Old Provision

Golden Ticket? Golden Ticket? Yes No

2 Year Old Provision - When would you like your child to attend? (Please tick as appropriate) 2 Year Old Provision - When would you like your child to attend? (Please tick as appropriate) Monday AM Monday PM Tuesday AM Tuesday PM Wednesday AM Wednesday PM Thursday AM Thursday PM Friday AM Friday PM

Children are entitled to 15 hours nursery provision which is five slots. When would you like your child to attend? (Please tick as appropriate) Children are entitled to 15 hours nursery provision which is five slots. When would you like your child to attend? (Please tick as appropriate) Monday AM Monday PM Tuesday AM Tuesday PM Wednesday AM Wednesday PM Thursday AM Thursday PM Friday AM Friday PM

30 hours eligibility? 30 hours eligibility? Yes

30 hours code

Would you like to access wrap around care via 'Busy Bees'. If so, please state when you would like this. Leave blank if not required.

Would you like your child to stay for lunch? Prices available on request. Would you like your child to stay for lunch? Prices available on request. Yes No