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Name of child:

Date of birth:

Name of parent / carer 1:

Name of parent / carer 2:

Address of parents / carers:

Home telephone number:

Mobile number:

E-mail address:

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

Once your child is offered a place and you accept it, on admission further personal information and family details are required for our records. You are required to show your child’s birth certificate at the point of registration as proof of age.

If you find that you no longer need the place, please inform us as soon as possible. Should you decide you no longer need the place we will not retain the details on this application form (see our Privacy Notice). Please be advised that this application form and offer of a place is subject to our terms and conditions provided to you. By signing this document, you acknowledge that you have read, understood and agree to these terms and conditions.

Please tell us where you heard about us?

Signature of Parent(s)/Carer(s):

Thank you for your application. If you have not heard back from us within 48 hours, please call the nursery to confirm that you application has been received.

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