Nursery Application Form

YOU MUST ANSWER ALL QUESTIONS and PROVIDE ALL REQUESTED INFORMATION. If you do not, your form will be returned to you and your application will be delayed.

Your child's details

Surname* First name(s)*

Gender*MaleFemale

Date of birth* Child's Main Address Postcode

Is your child looked after, or previously looked after, by a local authority (e.g. foster care)?*YesNo

If yes, please provide the following information:

Carer's Name, Address & Tel. No. Social Worker's Name, Work Address & Tel. No. Name of Local Authority

Your Details - please give details of all persons who have parental responsibility

Adult 1

First name:* Surname:* Your address (if different from child's) Postcode: What is your relationship to the child? (e.g. mother, father)* Name of local authority to which you pay your council tax:* Home telephone Mobile telephone* Email address:*

Do you have parental responsibility of the child?*YesNo

Current Education

What is the name of your child's previous School, Playgroup or Childrens Centre?

Is your child still attending this school?YesNo

Does your child have a brother/sister in school?*YesNo

If you answered yes, please state their name and Year Group

Does the child have a disability or medical condition?*YesNo

If YES, please provide details below

Data Protection Act 1998

The school is registered under the Data Protection Act for holding personal data.
The school has a duty to protect this information and to keep it up to date.
The school is required to share some of the data with the Local Authority and with the Dfes.

Full name* Relationship to child*

Tick the box to confirm electronic signature*Electronic Signature