Admission Form

Child's Information

Full name of child* Gender* Known name* Date of birth* Current age*

Parents/Carers

Contact (1)

Title* Name* Address* Post Code* Tel* Email* Place of work Work Tel Relationship to child*

Contact (2)

Title Name* Address* Post Code* Tel* Email* Place of work Work tel Relationship to child*

Alternative Emergency Contacts

(3)

Title Name Address Post Code Tel Relationship to child

(4)

Title Name Address Post Code Tel Relationship to child

Please continue to next page (hours)

Hours

2 year old funded sessions

The 15 hours a week offer:

Monday - Friday during term time - Every morning or afternoon, please select your preference. You will need a 2 year funding number .

(Specific timings will be dependent on your child's group)

Select one of the followingMorningAfternoon

2 year old Purchased sessions

1 session - £22.00

Monday - Friday during term time - please choose your preference and indicate below which days you would prefer.

(Specific timings will be dependent on your child's group)

Select one of the followingMorningAfternoon

What days?

3 year old funded sessions

The 15 hours a week offer:

Monday - Friday during term time - Every morning or afternoon, please select your preference.

(Specific timings will be dependent on your child's group)

Select one of the followingMorningAfternoon

The 30 hours a week offer (3 & 4 year old's)

Option A: 8:30am - 2:30pm Monday - Friday during term time.
Option B: 8:30am - 4:00pm Tuesday - Friday during term time.

Children will need a healthy packed lunch

Select one of the followingOption A: Monday - Friday - 8:30am - 2:30pmOption B: Tuesday - Friday - 8:30am - 4:00pm

If you need to check your eligibility, refer to the 'Funding and Session Structures' page in our 'About Us' area.

Wrap around sessions

These sessions will only be able to go ahead if we have enough children attending in the 'bubble' groups.

If you have a funded place there will be a weekly charge to cover the children's snack and cookery ingredients as these are not covered in the costs the government pays us to deliver the free Early Education and Childcare places. The amount will be £3 a week for 30 hours places and £1.50 a week for the 15 hours places. paid Termly

2 Year old Funding Child ID No: 30 Hours funded place reference number:

Medical Information

Medical Contacts and Details

Name of family doctor Address: Tel: Name of Health Visitor Address Tel:

Does your child suffer from any of the following?AstmaEczemaAllergies

If they suffer with any allergies please specify below Any other medical condition? (if so, please specify below)

Does your child have difficulty with any of the following:EyesightHearingSpeech and Language

Does your child have contact with any of the following agencies:PeadiatricianSpeech and Language TherapistOccupational TherapistBehaviour Support

Any other Agencies, if so please specify below

Support and Young Children Opportunities

Name of Social worker (if any)

Are you registered at a Children's Centre?YesNo

Name of Children's Centre (if any) Do you and your Child attend any groups at the Children's Centre? Preschool/Daycare attended (if any) Number of terms attended Which Primary School/Academy will he/she be attending?

Service Children

Is either parent service personnel, serving in regular HM Forces Military units of all forces and exercising parental care and responsibility?

Please selectYesNo

This is only relevant to children whose parents are designated as Personnel Category 1 or 2 which are shown on the MoD website, however all parents will be aware of their Personnel Category.

This information will be of use to help identify both the impact that being a service child has on their education and the impact that catering for large numbers of service children has on the school. Please note, however, that data on individual pupils is not being shared with the MoD.

Parent(s)/Carer(s) Print name: Date:

PLEASE NOTE:

You will be asked to produce your child's birth certificate. Please ensure it is available for our Home Visitor to see on her first visit to you, alternatively you may bring it to the school office on the first of your child's pre-school visits. Your child will be unable to start Nursery until we have completed this formality.

Parental Consent

INTERNET ACCESS

Please sign below if you give permission for your child to access the internet on the classroom computers.

Signature of Parent(s)/Carer(s) Date

CLASS OUTINGS

There are occasions when we take children out of school on short educational outings around the estate (e.g. visits to Tesco, Wragby Road Post Office, local shops, St Giles Community Garden, etc), accompanied by a minimum of two staff members. The outings are usually linked to our topic of work and the children benefit greatly from these first hand experiences. Please sign below if your agreeable to your child to participating in these outings.

Signature of Parent(s)/Carer(s) Date

ANIMAL HANDLING

The school currently has a guinea pig and chickens on site and occasionally other animals may be brought into school. The animals, very positively support children's learning and development as it provides the with first-hand experience of observing and taking care of living things. Please sign below if you are happy for your child to handle school animals.

Signature of Parent(s)/Carer(s) Date

EARLY YEAR PUPIL PREMIUM

The information may also enable us to apply for Pupil Premium which is additional funding for the children granted by the government.

If you are agreeable to providing us with this information please complete below, giving full names and date of birth of both parents together with National Insurance Numbers.

Please complete details below

	Parent/Carer 1	Parent/Carer 2
Full Name
Date of Birth
National Insurance No.
Signature
Date

Ethnic Information

The department of education requires Local Education Authorities to collect statistical data about pupils in it's schools. It would be helpful, therefore, if you could complete the following.

(1) ETHNIC ORIGIN

It is the child's heritage that is being asked for here. Where the child has dual or multiple heritages, that is descended from more than one ethnic or racial group, the ethnic group to which it is considered the child belongs should be given

WhiteBritishIrishAny other White background

If other please specify below

Black or Black BritishCaribbeanAfricanAny other Black background

If other please specify below

Asian or Asian BritishIndianPakistaniBangladeshiAny other Asian background

If other please specify below

MixedWhite and Black CaribbeanWhite and Black AfricanWhite and AsianAny other mixed background

If other please specify below

Other Ethnic GroupChineseOther

If other please specify below

NationalityUnited KingdomOther

If other please specify below

COUNTRY OF BIRTHUnited KingdomOther

If other please specify below

(4) HOME LANGUAGE
The response here should be the main language that is spoken in the home.

If other please specify below

(5) RELIGION
Although the child may not be a practicing member of the religion, it is the religious affiliation asked for here.

If other please specify below

Photo and Tapestry Online Learning Journey Permission

We would like to take photographs and videos to share with you;
- What your child is enjoying at nursery
- Share their friendships and interactions with others
- To record their progress, special events and achievements
- To include in newsletters and displays
- To share on for publicity purposes, on our website and local media

Please complete the following permission.

You will be emailed details of your Tapestry password when this form is returned to School.

Childs Name*

I agree to my child having a Tapestry Online Learning Journey.*YesNo

I consent to photographs & videos of my child being captured at nursery.*YesNo

I consent to photographs/videos of my child's image included in other children's tapestry*YesNo

I consent to photos/videos being displayed within nursery.*YesNo

I consent to my child's photos/videos being used for nursery publicity.*YesNo

I agree and understand that I must not post any consent from my child's learning journey on any social networking site, e.g. Facebook or Twitter. Photos are for my personal use only.*Accept

Failure to abide will result in your child's Online Learning Journey being suspended.

Parent/Carer Name* Parent/Carers e-mail address*

Admission Form

Child's Information

Parents/Carers

Alternative Emergency Contacts

Hours

Medical Information

Support and Young Children Opportunities

Parental Consent

Ethnic Information

Photo and Tapestry Online Learning Journey Permission

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