School name, address, contact details and logo

Application for a nursery place

Child’s details 	
Surname		
Forename		Gender		
Middle name		Date of birth		
Current childcare		

Home address	
Flat no / building name			
Number / street			
District		
Town		Post code		

Contact details for parent/carer	
Title: Mr/Mrs/Miss/Ms		Phone (day)		
Surname		Phone (evening)		
Forename		Phone (mobile)		
Email address		
Relationship to child		Do you have parental responsibility?	Yes / No	

Brothers or sisters who will be attending at the same time	
Name:		DOB:		
Name:		DOB:		
Name:		DOB:		
Name:		DOB:		

Faith - use this section if faith or church attendance is used to determine who is offered a place	
Attach a copy of baptism certificate or a letter from your priest confirming that your child is baptised, if applicable.	
Is your child baptised?	Yes / No	If yes, which denomination?		
Place of baptism		Baptism date		Certificate attached  	

Additional information about your child	
Does your child have an education, health and care plan?	Yes / No	
Is your child “looked after” by a local authority (in care)?	Yes / No	
If yes, which local authority?		

Please return this application form to: 

Your school name, address, email