Parent/Carer Name *

First Name

Last Name

Gender of Pupil

Boy

Girl

Date of Birth

MM

DD

YYYY

Verification method you will be using

Birth Certificate

Utility Bill / Other

Evidence to support financial implications/NI number

Child's Name

First Name

Last Name

Child's Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Name of Child's Prime Carer:

First Name

Last Name

Phone

(###)

###

####

Permanent Address:

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Name of Child's Second Carer:

First Name

Last Name

Phone

(###)

###

####

Permanent Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Does your child stay with a child minder?

Yes

No

Has your child any pre-nursery experience?

Yes

No

Have you applied for a Foundation 1 place anywhere else?

Yes

No

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Please show if you have a preference for session:

30 Hour Funded

Morning (8.50–11.50am)

Afternoon (12.20–3:20pm)

Monday & Tuesday full day, Wed. am

Wed. pm, Thursday & Friday full day