0-3yrs 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 *

Fee Paying Orchard Room Places – for 3 months to 3 years old - Please indicate your preferred childcare requirements by ticking the appropriate boxes below. Children must attend a minimum of three morning or afternoon session. The Orchard Room will be closed each year for 10 closure days, 5 inset days and all statutory public holidays; you will not be charged for these days.

8.00am – 1.00pm £32.00 includes breakfast and lunch

8.00am – 4.30pm £53.00 includes breakfast lunch and tea

8.00am – 6.00pm £63.00 includes breakfast lunch and tea

1.00pm – 4.30pm £22.00 includes tea

1.00pm – 6.00pm £32 includes tea

2 Year Funded Children Some 2 year olds will be entitled to free funded childcare of 15 hours per week during term time, starting the term after their second birthday. You will need to provide your valid funding code before we can process your application. For more information and to check your eligibility please go to: www.childcarechoices.gov.uk

Have you applied for or been accepted for 2 Year Funding?

2 Year Funding Reference Number

If eligible please choose one of the following attendance patterns (term time only):

Mornings, Monday - Friday 8.45am – 11.45am
Afternoons, Monday - Friday 12.45pm – 15.45pm

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

Vacancy – Key Worker – all year round

Vacancy – House Keeping and Lunchtime Assistant