Bluebells Nursery Application Form

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Thank you for applying to Bluebells Nursery at Brooklands Primary School. We accept children from the age of 3 in our Nursery, and have both part-time and full time funded and non-funded spaces, including for those eligible for 30 hours free childcare.

If you need any help in completing this form or have additional questions please contact the school on 020 8852 8210 or email info@bpsmat.org

Your child's first name *

Your child's surname *

Your child's gender *

Your child's date of birth *

YYYY

Name of first parent/ guardian *

Address of first parent/ guardian *

Postcode of first parent/ guardian *

Email of first parent/ guardian *

Telephone number of first parent/ guardian *

Name of second parent/ guardian *

Address of second parent/ guardian *

Postcode of second parent/ guardian *

Telephone number of second parent/ guardian *

Email of second parent/ guardian *

Address child spends most nights per week *

Which nursery provision option do you wish your child to attend? *

part time mornings only (15 hours funded)

part time afternoons only (15 hours funded)

Full time 30 hour funded place (see https://www.gov.uk/30-hours-free-childcare for eligibility)

Full time - 30 hours (part funded from 15 hour offer and part privately funded)

Does your child have any siblings already attending Brooklands Primary School? If yes please let us know their names and year groups. *

Has your child previously attended a Nursery?

Yes

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Does your child have any exceptional medical, social, emotional or other needs? If so, please provide details of the nature of these needs and the support that your child is currently getting. *

Is there any additional information you feel we may need to know? E.g. is your child a Looked After Child? *

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