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Application Form for 3-4 year old Nursery Place
For Universal 15 hours, 30 hours or self funded childcare
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* Indicates required question
Email
*
Your email
Child's Forename
*
Your answer
Child's last name
*
Your answer
Child's D.O.B
*
MM
/
DD
/
YYYY
Child's gender
*
Female
Male
Other:
Parent/carer name
*
Your answer
Email address
*
Your answer
Phone number
*
Your answer
Home address (must be where the child lives)
*
Your answer
Postcode
*
Your answer
Parent 2 name (please complete where applicable)
Your answer
Parent 2 email address & Phone Number (please complete where applicable)
Your answer
Session choice
*
AM session 8:30-11:30 15 hours per week Mon-Fri
PM session 12:30-3:30 15 hours per week Mon-Fri
8:30-3:30 (30 hours funded) Term time Mon-Fri
Paid place (not eligible for 30 hours)
Flexible place 2.5 days per week Mon 9-3, Tue 9-3, Wed 8:30-11:30 AM
Flexible place 2.5 days per week Wed 12:30-3:30PM, 9-3Thur, 9-3Fri
Wrap around care (Breakfast & afterschool club
Required
30 hours place
*
Choose
yes
No
30 hours code:
Your answer
Interested in holiday provision?
*
Yes
No
Which term is this application for?
*
April 2024
September 2024
January 2025
Other:
Required
Does your child have any of the following professionals involved due to either health issues or special educational needs?
*
Speech and language team
Moor Lane team
Hospital team
Social work team
any other
none
Required
Any other comments
Your answer
A copy of your responses will be emailed to the address you provided.
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