Admissions

Child's Name *

First Name

Last Name

Date of Birth *

MM

DD

YYYY

Name of Child's Mother *

First Name

Last Name

Permanent Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Telephone Number *

(###)

###

####

Does your child stay with a child minder? *

Option 1

Option 2

Is your child toilet trained? *

Option 1

Option 2

Emergency Contact 1 Name

First Name

Last Name

Emergency Contact 1 Phone Number

Country

(###)

###

####

Relationship

Mother

Father

Grandparent

Godparent

Friend

Other

Emergency Contact 2 Name *

First Name

Last Name

Emergency Contact 2 Phone Number

Country

(###)

###

####

Name of Family Doctor *

First Name

Last Name

Practice Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Name of Health Visitor

If applicable

First Name

Last Name

Telephone Number

(###)

###

####

Name of Social Worker

If applicable

First Name

Last Name

Telephone Number

(###)

###

####

Have you applied for a nursery place in any other setting? *

Yes

No

Date of Birth

MM

DD

YYYY

Additional siblings

Please list the names and dates of birth (use additional information section if required)

First Name

Last Name

Date of Birth

MM

DD

YYYY

If your application is successful please state a preference of session and we will try to accommodate this. *

Morning Session

Afternoon Session

No Preference

Child's Date of Birth *

MM

DD

YYYY

Child's Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Name of legal guardian *

First Name

Last Name

Mothers Name *

First Name

Last Name

Mothers Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Mothers DOB *

MM

DD

YYYY

Fathers Name *

First Name

Last Name

Fathers Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Fathers DOB *

MM

DD

YYYY

Please indicate in there is any social care involvement eg social worker

Yes

No

Method of travel to school

Walk

Car

Local Authority Transport

Ethnic Origin *

White (European origin inc UK)

White (other)

Black (African origin)

Black (Afro Caribbean)

Other

Meal arrangements *

Eligible for free school meals

Paid school meal

Packed Lunch

Not applicable nursery child

Medical Questionnaire *

Hearing Impairment

Speech Therapy

Asthma

Epilepsy

Allergies

None

Does your child wear glasses *

Yes

No

We occasionally receive additional funding if children are looked after by somebody other than their parents. Please indicate if any of the following categories apply to your family situation *

Looked after by family (not parents)

Special guardianship

Army Forces

In care LAC

None of the above

Permission requests *

I give permission for the safe and responsible use of the virtual learning environment (this includes internet & email)

I give permission for my child to be photographed and to be published on the school website and in school displays.

I give permission to travel on coaches, public transport and local school trips.

I give permission for my child to participate in food tasting activities.

I give permission for my child to receive medical wipes and plasters as and when required