Rimrose Hope Nursery Application Form
This is an application form for Rimrose Hope Nursery for 3 and 4 years olds (children to start the term after their third birthday e.g. if your child's 3rd birthday falls within the Summer Term (April 1st-August 31st) then they will be eligible for a place in Nursery in the Autumn  Term (September). Working parents can apply for a code for 30 hours, this can be found on the childcare choices website. Due to oversubscription, we advise parents to complete a form so that their child can be placed on a waiting list to ensure a place. Once your form has been received you will be contacted by Mrs. Warrington (Early Years Lead and Assistant Headteacher)
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Full name of child  *
Date of Birth  *
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Male/Female *
Ethnic Origin  *
First Language  *
Does your child have an older sibling?  *
If yes, please state what school they attend
Mother's full name
Father’s full name 
Guardian/Carer’s full name 
Name of those with Parental Responsibility  *
Home Address (including postcode) *
Contact number *
Email address *
Does your child have any medical needs, including allergies and asthma?  *
If yes, provide details below
Please select hours  *
If you have selected 15 hours, please state your preference for morning or afternoon sessions. (We can not always guarantee we will be able to provide the selected time session, but we will try our best to accommodate)  
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Does your child have any identified special needs? *
If yes, please provide details including any agency involvement e.g. speech therapy, physiotherapist etc.
Do you intend to keep your child at Rimrose Hope Primary School for a place in Reception?   *
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