Preschool Application Form

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Email *

Child's Forename *

Child's Middle name

Child's Surname *

Child's Date of Birth *

YYYY

Child's Gender *

Male

Female

Do you have any sibling/s at James Dixon *

Child's Home Address (with postcode) *

Home Phone Number

Is the Child toilet trained or actively toilet training *

Yes

Adult 1:Title *

Parent/Carer

Adult 1:Full Name *

Parent/Carer

Adult 1:Home Address *

Adult 1:Email Address *

Adult 1:Date of Birth *

YYYY

Adult 1:Country of Origin *

Adult 1:Mobile Phone *

Adult 1:Home Phone Number *

Adult 1:National Insurance Number or NASS *

Adult 1:Are you on the electoral roll for the address provided *

Yes

Adult 2:Title

Parent/Carer

Adult 2:Full Name

Parent/Carer

Adult 2:Home Address

Adult 2:Email Address

Adult 2:Date of Birth

YYYY

Adult 2:Country of Origin

Adult 2:Mobile Phone

Adult 2:Home Phone Number

Adult 2:National Insurance Number or NASS

Adult 2:Are you on the electoral roll for the address provided

Yes

Clear selection

Additional Contact 1 (Name, Number & Relationship) *

OTHER CONTACTS WHO COULD TAKE CHARGE OF YOUR CHILD IF YOU CANNOT BE REACHED

Additional Contact 2 (Name, Number & Relationship)

OTHER CONTACTS WHO COULD TAKE CHARGE OF YOUR CHILD IF YOU CANNOT BE REACHED

Ethnicity *

African

Caribbean

Black British

White British

Black & White background

Black & White African

White & Asian

Bangladeshi

Any other mixed background

I do not wish an Ethnic background recorded

Other:

Is English your child's first language *

Yes

If No, please provide details of the first language your child has been brought up in

Are there any Court Orders relating to your child *

Yes

Is your child looked after by a Local Authority *

Yes

Please provide details of any previous Preschools your child has attended

Has your child been diagnosed with any of the following *

Asthma

Diabetes

Hayfever

Epilepsy

Nut Allergy

Food Allergy

None

Other:

Required

Has your child been prescribed medication for their condition *

Yes

Not Applicable

Any concerns regarding development (speech & language, dietary, swallowing, physical or sensory needs) Or SEND / any other needs *

Yes

Other:

If Yes to any concerns / needs please provide details

Disability Access Fund for DLA Children *

3 and 4 year olds claiming their free entitlement and who are in receipt of Disability Living Allowance (DLA) will be eligible for Disability Access Fund (DAF). This will be paid directly to this provider to help make reasonable adjustments to their settings.

Yes my child is in receipt of DLA and I would like this provider to claim the DAF

I have sent/emailed a copy of the DWP letter to the provider

Not Applicable

Required

Applications will only be accepted if accompanied with BOTH originals of the following supporting documents. Please bring documents at these times only 8.15am-8.30am or 3.00pm-3.30pm *

The name on the document must be that of the parent/carer signing the application and with whom the child lives with.

Your Child's Full Birth Certificate

Child Benefit Letter / Council Tax Letter

Required

Please indicate which session you would prefer *

There is no guarantee that we accommodate this request

Morning (15hrs) 8.30am - 11.30am

Afternoon (15hrs) 12.15pm - 3.15pm

All Day (30hrs) 8.30am - 3.15pm

If requesting the All Day (30hrs), please provide 30hr code under Other *

Please read all relevant information on our website https://www.jamesdixon.bromley.sch.uk/preschool-places/

Not Applying for All Day (30hrs)

Other:

30 Hours Funded Childcare Fees *

Please see on our website information for the additional fee of £7 per day (late payment fees may apply)

I have read the information on 30 Hours Funded Childcare Fees and agree to make the additional £7 per day

Not Applying for All Day (30hrs)

Required

SAFEGUARDING - We operate a password system for children who attend our Preschool. If someone other than yourself is collecting your child from school they will need to know the child’s unique password. If you are not sure of your child’s password please see the class teacher. *

DECLARATION - By submitting the form I have read and understood the notes in the Information Sheet and the arrangements set out for the allocation of Preschool places *

I accept, in particular, that: 1.There is no guarantee that a place can be made available at this Preschool. 2. The length of time that my child’s name has been on the waiting list will not be taken into account when places are allocate. 3. The offer of a place in the Preschool carries no guarantee of a Reception place in the same school in the following year. 4. Notice to leave is 4 weeks, this must be a written notice during term time.

I have read all documents included in this application and filled out all relevant forms required

Required

A copy of your responses will be emailed to the address you provided.

Submit

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