Application Form

Child's Full Name

Male/Female

Child's Date of Birth

Year

Month

Day

Preferred Start Date

1st Parent/Guardian Full Name

2nd Parent/Guardian Full Name

Are you a member of HM forces? Yes/No

Are you a member of the HM forces? Yes/No

1st Parent/Guardian Address

Please add the address of the child if different from above

2nd Parent/Guardian Address

Please complete if different from parent 1

1st Parent Phone Number

2nd Parent Phone Number

1) Email

2) Email

Child's Ethnic Origin

Child's Nationality

Child's Religion

Languages Spoken at Home/ Understands

Does your child attend another setting? Yes/No

Name of other setting

Please Provide any medical details or special educational needs that the preschool should be aware of

Please provide details of any other services that have been involved with the child

Working Families eligibility code (if applicable)

2-Year old eligibility code (if applicable)

Parent NI Number

This is required to confirm eligibility code.

Blocks

Block 1- 8.30-9.00

Block 2- 8.30-11.30

Block 3- 12.00-3.00

Block 4- 9.00-3.00

Please select your preference of hours.

How did you hear about us?

A £40 Joining fee is required if you are not in receipt of early years funding for your child. Once we receive your application, you will receive an invoice for this fee. NB your child will not be fully registered until this has been received.

The information on this form is correct to the best of my knowledge and belief. If we find we no longer need the place, we will inform the preschool as soon as possible.

I understand that the submission of this application form does not indicate that the preschool can offer a place to the child.

A place at St Bernadette's Bees Preschool does not guarantee a place at St Bernadette's Catholic Primary School which has it's own separate admissions policy.

Signed Full Name

Signature

Signature field is empty.