Child's Name *

    First

    Last

    Gender *

    Child's Date of Birth *

    Home Address *

    Postcode

    Child's Ethnic Origin *

    Child's Nationality *

    Child's Country of Birth *

    Religion *

    Child's First Language *

    Other Languages Spoken *

    Parent / Carer 1 Name *

    Parent / Carer 1 Title *

    Parent / Carer 1 Date of Birth

    Lone Parent *

    Parent / Carer 1 Phone Number *
    Parent / Carer 1 Email Address *

    Parent / Carer 1 Nationality *

    Parent / Carer 1 National Insurance Number *

    Parent / Carer 1 Occupation *
    Employer *

    Parent / Carer 2 Name

    Parent / Carer 2 Title

    Parent / Carer 2 Date of Birth

    Parent / Carer 2 Phone Number

    Parent / Carer 2 Email Address

    Parent / Carer 2 Address (if different from child)

    Parent / Carer 2 Nationality

    Parent / Carer 2 National Insurance Number

    Parent / Carer 2 Occupation

    Employer

    Does your child have additional needs or health issues? *
    Please give details

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

    Is your child “looked after” or supported by an Early Help Plan or children's Services? *
    Please give details

    Do you give permission for us to seek further information from other professionals who work with your child/family to support your application?

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

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

    Do you give permission for us to use your details to check your child’s eligibility for Early Years Pupil Premium under the economic criteria?

    Has your child attended any other childcare settings? e.g. childminder, relatives or another nursery setting. *
    Please give details.

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

    Preferred Start Date *

    Childcare funding is being expanded to working families with children under the age of 3 years old. The existing Local Authority funding which is offered to eligible 2 year olds is continuing. For more information and to check your eligibility to funding before completing this application we recommend visiting: www.childcarechoices.gov.uk

    All funded and paid sessions are offered term time only. The Nursery School and Orchard Room will be closed each year for 10 closure days, 5 inset days and all statutory public holidays. A holiday club is offered outside of term time and places are subject to availability. Booking forms are sent to families each term.

    Families are responsible for applying for and providing a valid funding code prior to their child starting at the nursery. Below is the government guidance on when to apply for a code and when your child’s funding eligibility will start:

    From 2 years old a child born on or between

    Recommended time to apply

    Funding eligibility starts from

    1st April to 31st August

    1st July to 15th August

    September after their 2nd birthday

    1st September to 31st December

    1st November to 15th December

    January after their 2nd birthday

    1st December to 31st March

    1st February to 15th March

    April after their 2nd birthday

    From 9 months old a child born on or between

    Recommended time to apply

    Funding eligibility starts from

    1st April to 30th June

    1st February to 15th March

    April after turning 9 months old

    1st July to 30th November

    1st July to 15th August

    September after turning 9 months old

    1st December to 31st March

    1st November to 15th December

    January after turning 9 months old

    Please answer the questions below to help us confirm your eligibility for funding:

    Funding for Working Families (and if you are intending to return to work)

    Do you, and any partner, expect to earn £167 per week (on average)?

    Do you, and any partner, each expect to earn less than £100,000 per year?

    Do you, and any partner, have a National Insurance Number?

    Do any of the following apply:

    Do you, and any partner, have British or Irish citizenship?
    Do you, and any partner, have settled or pre-settled status (or have applied)?
    Do you, and any partner, have permission to access public funds?

    If you have answered YES to ALL of the questions above please complete Section A or B below depending on the age of your child.

    For more information and to apply for a code:
    www.gov.uk/apply-free-childcare-if-youre-working

    Local Authority Funding for 2 Year Olds

    Are you in receipt of any of the following benefits:

    Income Support; Income Based Jobseekers Allowance or Income related Employment and Support Allowance

    Universal Credit with a household income below £15,400

    Child Credit and/or Working Tax Credit with a household income below £16,190

    Does the child meet any of the following criteria:

    Are they looked after by a local authority

    Have they been adopted or do they have a Special Guardianship Order

    Do they receive Disability Living Allowance

    Do they have an Education, Health and Care Plan

    If you have answered YES to either of the questions above please complete Section C below.

    For more information and to apply for a code: www.westsussex.gov.uk/education-children-and-families/childcare-and-early-education/

    *If you have answered NO to the questions above you may not be eligible for either funding stream. Please complete Section A or B below and be aware that all sessions will be payable in full.

    Section A

    Please indicate which sessions you require for children aged 3 to 23 months in receipt of Working Families Funding (offered as two full days and one half day) or for paid sessions.

    8.00am – 8.30am: £6.00, includes breakfast
    MondayTuesdayWednesdayThursdayFriday

    8.30am – 9.30am: £11.00

    Core Morning * 9.30am – 12.30pm
    Funded if eligible or £35.00

    Core Afternoon 12.30pm – 3.30pm
    Funded if eligible or £35.00

    3.30pm – 5.00pm: £18.00, includes tea

    *Children will have lunch between 11.30am to 12.30pm. Will you require a hot lunch at £7 per day or will you provide a packed lunch at no additional cost?
    It is not possible to mix and match packed lunches and hot lunches.

    Section B

    Please indicate which sessions you require for children aged 24 to 36 months in receipt of Working Families Funding (offered as two full days and one half day) or for paid sessions.

    8.00am – 8.30am: £5.50, includes breakfast
    MondayTuesdayWednesdayThursdayFriday

    8.30am – 9.30am: £8.50

    Core Morning * 9.30am – 12.30pm
    Funded if eligible or £25.00

    Core Afternoon 12.30pm – 3.30pm
    Funded if eligible or £25.00

    3.30pm – 5.00pm: £14.00, includes tea

    *Children will have lunch between 11.30am to 12.30pm. Will you require a hot lunch at £7 per day or will you provide a packed lunch at no additional cost?
    It is not possible to mix and match packed lunches and hot lunches.

    Section C

    Please select which place you require for two year olds in receipt of Local Authority Funding

    Local Authority Funding Reference Number:

    Signature
    Please write your name to confirm you have parental responsibility (see below) for the child named in this application.

    Definition of Parental Responsibility
    Under the Children Act 1989, the following people have “parental responsibility”:
    • the mother
    • the father if he was married to the child’s mother at the time of the child’s birth
    • the father if he registered the child’s birth jointly with the mother, has subsequently married the child’s mother, through a ‘parental responsibility agreement’ between him and the child’s mother that is registered with the court, by obtaining a court order for parental responsibility.
    • If two female parents have a child through fertility treatment, the mother’s female partner is treated in the same way as a father. She has parental responsibility if she is married to or in civil partnership with the mother or she can acquire parental responsibility in the same way that a child’s father can.

    Parental responsibility can also be acquired through: adoption or prospective adoption, by obtaining a parental order following a surrogacy, being a step-parent (through agreement with the child’s mother and their other parent or as the result of a court order), being granted a child arrangements order determining who a child should live with, being appointed as a guardian or special guardian, being named in an emergency protection order, being the local authority named in the care order for a child.