Application Form
Nursery Admissions - Please select your language above 
Application forms for Nursery September 2023 are now available. Please see the document below for full information about how to apply for a place in Nursery.
To register eligibility for a 30hr Nursery Place parents must register on-line at https://www.gov.uk/apply-30-hours-free-childcare
Please see the Nursery Admissions Policy for full details of places available and eligibility for 30 hours.
APPLICATION FOR A NURSERY PLACE
CHILD’S DETAILS
Surname | Forenames | Preferred Forename | Boy/Girl | Date of Birth |
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Place of Birth:
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Current Address | Postcode | Home Phone | ||
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If your child currently attends nursery/playgroup and/or any other childcare provision, please give details:
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FAMILY AND CONTACT DETAILS (Please indicate, next to each person’s name, the order in which they should be contacted in an emergency, i.e. 1st, 2nd, 3rd)
Parent’s Full Name & Relationship to Child | Address (if different from child) | Contact Order | Phone Numbers |
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| 1 / 2 | Home |
Work | |||
Mobile | |||
Parent’s email address:
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Parent’s Full Name & Relationship to Child | Address (if different from child) | Contact Order | Phone Numbers |
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| 1 / 2 | Home |
Work | |||
Mobile | |||
Parent’s email address:
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Other information, e.g. Single Parent; access arrangements | |||
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Guardian’s/Carer’s Full Name (if applicable) | Address (if different from child) | Contact Order | Phone Numbers |
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Work | |||
Mobile | |||
Guardian’s/Carer’s email address:
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Name(s) of person(s) with parental responsibility:
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Extra Emergency Contacts (names) | Relationship of contact to child | Contact Order | Phone Numbers |
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Work | |||
Mobile | |||
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| Home |
Work | |||
Mobile | |||
OTHER CHILDREN IN THE FAMILY
Number of children in the family: 1 ☐ 2 ☐ 3 ☐ 4 ☐ 5 ☐ 6 ☐ 7 ☐ Child's position in family: 1st ☐ 2nd ☐ 3rd ☐ 4th ☐ 5th ☐ 6th ☐ 7th ☐ (ie oldest) | ||
Name(s) of siblings | School attended | Date of birth |
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MEDICAL INFORMATION
Doctor’s Name | Name & address of surgery | Phone Number |
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Details of any medical conditions/allergies/special physical needs | ||
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Name of any other professionals involved with your child e.g. Speech Therapist/Orthoptist (who may check if your child has an eye squint) Portage worker/Social worker/Other - please specify:
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Please give any other information you think is appropriate:
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NEEDS OF THE CHILD
Is your child on the Child Protection Register? YES/NO | |
Does your child have any difficulties with - Speech YES/NO Hearing YES/NO Sight YES/NO Eczema YES/NO Asthma YES/NO Allergies YES/NO Anything else YES/NO
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Does your child receive support for special needs? YES/NO If yes, please give details
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Special dietary needs (e.g no meat; vegetarian; no pork/nuts/dairy; coeliac)
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NEEDS OF THE PARENT/CARER
Are you a single parent, living alone with your child/children? YES/NO | YES/NO |
Do you have other family members living nearby who can help you? YES/NO | YES/NO |
Do you meet the criteria for the additional 15 hours (total of 30 hours) of free childcare (see accompanying letter for criteria) | YES/NO |
If yes to the above, would you like for your child to attend the full 30 hours of free childcare? | YES/NO |
Do you work? YES/NO | YES/NO |
Are you in receipt of Income Support? YES/NO | YES/NO |
If you are in receipt of any other State Benefit (excluding Family Allowance) please specify:
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HOME CIRCUMSTANCES
Is your home overcrowded or are your living conditions unsuitable? YES/NO (If yes, please give details)
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Does your child have a safe outdoor play area at home? YES/NO
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Is a member of your household ill or disabled? YES/NO
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Do you have internet access? | YES/NO |
Are there any other family problems which should be taken into consideration? YES/NO (If yes, please give details)
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PLACEMENTS
Is your child's name on the waiting list of any other nursery? YES/NO (If yes, please indicate which nursery)
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If you are not eligible for 30 hours of funded childcare, you are invited to consider paid-for extended childcare provision.. Please tick the days you are interested in: Monday ☐ Tuesday ☐ Wednesday ☐ Thursday ☐ |
Please give any other information that we should know:
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It is very important that children in the Nursery feel confident about being away from their homes and families. One way in which you can help is to ensure that they are toilet-trained, so that they can use the toilet independently. Of course, staff will support children who need it, but our facilities for changing children’s clothes are very limited. We will be happy to discuss with you ways to help your child achieve this kind of independence.
ETHNIC AND CULTURAL INFORMATION
Our ethnic background describes how we think of ourselves. This may be based on many things, including, for example, our skin colour, language, culture, ancestry or family history. Ethnic background is not the same as nationality or country of birth.
Nationality (please tick one) | ||||||||||
English | Welsh | Scottish | Irish | British | Other (specify) | Information Refused | ||||
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Country of Birth (Provision of this information is optional) | First Language (ie first language used in your child’s early development) | Language(s) spoken at home | Language(s) read at home | Religion | ||||||
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Ethnic Background (Please tick one) | ||||||||||
White | Mixed | Asian/Asian British | ||||||||
☐ British ☐ Irish ☐ Gypsy/Roma ☐ Any other white background | ☐ White & Black Caribbean ☐ White & Black African ☐ White & Asian ☐ Any other mixed background | ☐ Indian ☐ Pakistani ☐ Bangladeshi ☐ Any other Asian background
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Black/Black British | Chinese/Chinese British | Any other background | ||||||||
☐ Caribbean ☐ African ☐ Any other black background | ☐ Chinese/Chinese British | ☐ Any other ethnic background
☐ I do not wish an ethnic background to be recorded
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I understand that completing this form neither guarantees my child a place in the nursery, nor a particular session:
Signature of Parent/Carer | Date |
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Please return completed form to:
The Business Manager
Sefton Park Schools
Ashley Down Road
Bristol BS7 9BJ
PLEASE NOTE - YOU MUST SHOW THE SCHOOL YOUR CHILD’S BIRTH CERTIFICATE WHEN
YOU RETURN THIS FORM.
Data Protection Act 1998: The school is registered under the Data Protection Act for holding personal data. The school has a duty to protect this information and keep it up to date. The school is required to share some of the data with the Local Authority and with the DfES. |