Nursery Only Registration Form

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If you would like to request a Nursery place at The Breakspear School please complete the following information.

Child's Surname *

Child's Forename *

Child's Gender *

Child's Date Of Birth *

YYYY

Please select your preference of :- *

I would like to take up a morning nursery place for 15 hours running from 8.30 to 11.30am, 5 mornings a week, during school term time (38 weeks a year).

I would like to take up an afternoon nursery place for 15 hours running from 12.30 to 3.30pm, 5 afternoons a week, during school term time (38 weeks a year).

I am eligible for the 30 hour Government funded provision as both parents are working 16 hours or more, at the national minimum wage or more, but earning no more than £100,000 per year. I would like to take up a full day nursery place for 30 hours running from 8.30am to 3.30pm, 5 days a week during school term time (38 weeks a year).

I no longer require a nursery place at The Breakspear School

If your first preference 15 hours place was not available would you consider the other 15 hour session?

Yes

Mothers Forename *

Mothers Surname *

Mothers Title

Mrs

Miss

Other:

Clear selection

Fathers Forename *

Fathers Surname *

Fathers Title

Other:

Clear selection

Address *

Post Code

Home Telephone Number *

Mobile Telephone Number *

Work Telephone Number

E-Mail Address *

Confirm E-Mail Address *

Please indicate any Health Problems / Special Needs / Additional Information

Do you have a Sibling attending The Breakspear School *

Please provide the names of any siblings that will be in school when your child joins in the September of the year they will be 4

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