Initial (NEW starters) Enquiry 2024 onwards 
Sign in to Google to save your progress. Learn more
Child's Name *
Child's D.O.B. *
MM
/
DD
/
YYYY
Parent's Name *
Parent's contact email address 
Address *
Phone Number *
Preferred Start Date *
MM
/
DD
/
YYYY
Does your child have any siblings?
 *
If yes, do any of them attend Parkside School?
Clear selection
Funded Place

Please follow this link for further information if you are unsure of funding options: www.childcarechoices.gov.uk

Please be aware that once offered a space at Preschool, we will need to see an original copy of your child’s ID and will ask you to complete the declaration for funding in order for us to claim this.

Are you eligible for the following funded place?

Clear selection
Medical Details

We need to know about any medical conditions your child may have. Please tick relevant boxes.

If there any other illnesses or conditions that we should be aware of, please give details.

If your child requires any ongoing medication then please give clear information about the name of the medication, strength and dose, even if it is not required during Preschool hours.

If your child has any allergies, dietary requirements or food intolerances then please provide details.

Session Information
Does your child attend another setting now or will they attend another setting alongside Parkside?
 *
Please tick the sessions you are requesting.
08:45-11:45
11:45-12:30
12:30-15:30
Monday
Tuesday
Wednesday
Thursday
Friday
Does your child have Special Educational Needs?    
Clear selection
If you have answered yes to the above, please information below

Does your child have contact with any outside agencies (or on the waiting list for) e.g. Children’s Centre Keywork, Speech Therapy, Social Services, Early Years Special Need Support, Early Years Emotional and Behavioural Intervention Service?

Clear selection
If you have answered yes to the above,  please specify which agency you have contact with.

Please give a brief birth history/ did you have any complications, was your child premature, were there any medical problems at birth?

Please tick this box to say you have read and agree to the Privacy Notice (how we use children’s information) and Terms and Conditions.
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Parkside Primary. Report Abuse
Google Forms