Application to join

Child's first name

Child's surname

Gender Boy Girl

Child's date of birth

Address

Post Code

Parent/Carer's (1) Details

Parent/Carer's name

Relationship to child

Full Address

Post Code

Email Address

Home Number

Mobile Number

Parent/Carer's (2) Details

Parent/Carer's name

Relationship to child

Address

Post Code

Email Address

Home Number

Mobile Number

Other important information

Does your child have any special educational needs? Yes No

Does your child have any medical needs? Yes No

If you answered yes to any of the above questions, please let us know the details below so we can better support your child.

Session Details?

Preferred Start Month

Preferred Start Year

Do you receive 2 year old funding? Yes No

If yes, please supply the referance number?

Are you eligible for 30 hour extended funding? Yes No

If yes, please supply the referance number?

How did you hear about us?

This application places your child on our waiting list. We will contact you as soon as a sutible place becomes available. Please note that compleation of this form does not guarantree a place for your child.

Once your child is offered a place and you accept it, on admissions further personal informtion and family details are required for our records. Your child's birth certificate or passport is required at this point to confirm eligibilty.

If you find you no longer need the place, please inform us as soon as possible. Should you no longer need the place we will not retain the details on this application form (see our Privacy Policy for more information).

Please be advised that this application form and offer of a place is subject to our terms and conditions provided to you. By submitting this form, you acknowledge that you have read, understood and agree to these terms and conditions.

Once you have been allocated a place at the playgroup, there is a £20 charge for your welcome pack and book bag for your child. This payment can be made by cash, cheque or bank transfer.