3-5yrs Application – Bognor Regis Nursery School

Child's Name *

First

Last

Gender *

Child's Date of Birth *

Child's Ethnic Origin *

Child's Country of Birth *

Child's Nationality *

Religion *

Home Address *

Child's Home Language *

Other Languages Spoken *

Parent / Carer 1 Name *

Parent / Carer 1 Title *

Parent / Carer 1 Email Address *

Lone Parent *

Parent / Carer 1 Phone Number *

Parent / Carer 1 Occupation *

Parent / Carer 1 National Insurance Number *

Parent / Carer 1 Ethnic Origin *

Parent / Carer 1 Nationality *

Parent / Carer 2 Name

Parent / Carer 2 Title

Parent / Carer 2 Phone Number

Parent / Carer 2 Occupation

Parent / Carer 2 National Insurance Number

Does your child have additional needs or health issues? *

Does your child receive support from the Child Development Centre, Speech and Language Therapy or other service? *

Is your child “looked after” or supported by an Early Help Plan or Social Services? *

Is your child accessing Disability Living Allowance (DLA)? *

Does your child have (or in the process of gaining) an Education, Health and Care Plan (EHCP)? *

Has your child attended any other childcare settings? E.g. childminder, relatives or another nursery setting. *

Preferred Start Date *

Funding entitlement starts the term after the child’s third birthday.

Have any of your older children attended our Nursery? If yes, with which Keyworker? *

Term Time Funded Sessions - Section A - Please complete if you are applying for a 15 hour Term Time place

Monday to Friday between 9.00am until 12.00pm
Monday to Friday between 1.00pm until 4.00pm

All 3 and 4 year old children can access Universal Free Entitlement funding of 15 hours nursery education per week during term time, starting the term after their third birthday. Some 3 and 4 year old children can access Extended Free Entitlement funding of 30 hours nursery education per week during term time, starting the term after their third birthday. You will need to apply for and provide a valid eligibility code to access a 30 hour funded place. For more information and to check your eligibility please go to www.childcarechoices.gov.uk

Term Time Funded Sessions - Section B - Please complete if you are applying for a 30 hour Term Time place

Monday to Friday between 9.00am until 4.00pm. I will collect my child for lunch between 12.00pm to 1.00pm
Monday to Friday between 9.00am until 4.00pm. I will pay for the lunchtime session between 12.00pm to 1.00pm at £8.50 per day

Breakfast 8.00am – 9.00am £8.50 (includes food)

Morning 9.00am – 12.00pm £17.00

Lunch 12.00pm – 1.00pm £8.50 (includes food)

Afternoon 1.00pm – 4.00pm £17.00

Afterschool 4.00pm – 6.00pm £12.00 (includes food)

Breakfast, Lunch and Tea 8.00am – 6.00pm £60.00

Please tick if you would like to be considered for a place in the Holiday Play Scheme. This would allow you to agree in advance 8 weeks attendance during school holidays; the sessions requested are payable and do not have to be the same as a child’s term time attendance.

I have parental rights for the child named in this application. *

Vacancy – Key Worker – all year round

Vacancy – House Keeping and Lunchtime Assistant