Application Form for Nursery

Headteacher: Fatemah Salihi

FOR ADMINISTRATIVE USE ONLY

Full Name of Child: …………………………………………………………………

Date Application received: ……..............

Copy of Birth Certificate attached:

Eligible for EYPP: Eligibility Code: …………………………………………

Date Acknowledgement Letter sent: ……..............

Date of Admission: ……..............

Action Taken: 1) Home visit 2) Admitted 3) Waiting List 4) Apologised

Admission Number:

If on waiting list, date of proposed admission: ………………………………........

Days & Hours required: ......................................................................................

Date of Termination:

COMPANY REGISTERED IN ENGLAND AND WALES. REGISTERED NUMBER 6410625

OFSTED URN. 135539 - DCSF NO. 821/6011 - CHARITY NO. 1123924
 PERSONAL DETAILS

Full Name of Child: ……………………………………..……………………………………………………………………………………………

Date of Birth: ……………………. Gender: Male / Female (please circle)

Age of Child on 1st September 20__: ……………………..

Address: ……………………………………………………………………………..........................................................................
…………………………………………………………………………………………………………………………………………………………………..
Town: …………………………………….. Postcode: ……………………...

Home Telephone: …..………………... (with STD)

Nationality: ………………………………. Place of Birth: …………………………
Religion: ………………………………. No. of children in family: ………..
Legal Status/ Visa Status / Immigration Status: ………………………………......

Full Name of Father / Guardian: ……………………………………………………………………………………………………………….

Country of Origin: ………………………………. E-mail: ………………………………………………..…………………….
National Insurance Number: .………………………. Date of Birth: ……………………………..…
Legal Status/ Visa Status / Immigration Status: ………………………………………………………………………………………….

Address with postcode:

……………………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………………

Home / Work………………………………. (with STD) Mobile: ……………………………….

Full Name of Mother / Guardian: ………………………………………………………….………………………………………………….

Country of Origin: …………………………………. E-mail: ………………………………………………..…………………….

National Insurance Number: ………………………………. Date of Birth:…………………………….……………………………….
Legal Status/ Visa Status / Immigration Status: ………………………………………………………………………………………...
Address with postcode:
……………………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………………

Home / Work: …………………... (with STD) Mobile: ....................................

Legal marital status:

Married Divorced Single

Who has parental responsibility for the child?...............................

Who does the child normally live with?......................................................................

Please state the primary contact for the child: ………………………………………………………

 INFORMATION IN CASE OF EMERGENCY
Place where Parents / Guardians can be contacted during the day

Full Name of Parent / Guardian: ………………………………………………………………………………………………………………

Workplace Full Address: working from home
……………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………Postcode: …………………….
Work Telephone: …………………....... (with STD)

Please provide details of someone whom we could contact (other than the Parent/Guardian) should your child
become ill and we cannot contact you.
Full Name: ……………………………. Telephone: ………………………….
Address:
………………………………………………………………………………………………………………………………………………………………………
……………………………………………………………………..........................................Postcode: ………………………....
Relationship to Child? …………….......................................................................................................................
Please provide details of someone whom we could contact (other than the Parent/Guardian) should your child
become ill and we cannot contact you.

Full Name: ……………………………. Telephone: …………………….

Address:……………………………………………………….............................................…………Postcode: ……………………...
Relationship to Child? ……………......................................................................................................................

ABOUT YOUR CHILD

What is your child’s first language at home?..............................................
Does your child speak English fluently? Yes No

Names of any siblings attending Oakwood Primary School: ……………………………………………

Does your child have any learning difficulties or special needs such as: ADHD, Speech and language, Autism.
Yes No
If yes, please describe:
………………………………………………………………………………………………………………………………………………………………….
………………………………………………………………………………………………………………………………………………………………….

Any outside agency involved, for example:

Special Education Needs (SEN), Health Visitor, Social Care Services, Hospital Consultant, Dietician, Speech &
Language Therapy (SALT), IDVA/ MARAC, Early Help Assessment team (EHA)

If yes, please describe:

…………………………………………………………………………………………………………………………………………………………………..
…………………………………………………………………………………………………………………………………………………………………..

Who has legal contact with the child? Mum Dad Both

Any other cases related to your child:

Child Protection Looked After Court Order in place

Name of key person/ lead professional in case work and contact details:
…………………………………………………………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………………………………………………………

MEDICAL INFORMATION
Has your child had the following check-ups done, please tick below:

2 MONTH DTaP-IPV-Hib, PCV, Rotavirus

3 MOTNH DTaP-IPV-Hib, PCV, Rotavirus

4 MONTH DTaP-IPV-Hib, PCV, Rotavirus

12 MONTH MMR, Varicella, Hepatitis A

18 MONTH Hepatitis A

2-3 YEARS Catch-up vaccines

4-5 YEARS DTaP-IPV, MMR-Varicella

Full Name of Child’s Doctor: ……………………………………….................................................................................

Full Name / Address of Surgery:
………………………………………………………………………………………………………………………………………………………………….
Postcode: ………………………………………. Telephone: ………………….....

Does your child suffer from any illness, disability or allergy? Yes No
If Yes, please give further details: ………………………………………………….
……………………………………………………………………………………….....
Does your child have any special dietary requirements? Yes No
If Yes, please give details, particularly of the foods to avoid: …………………...
……………………………………………………………………………………….....

Does your child wear glasses? Yes No

Does your child wear a hearing aid? Yes No
Will your child be bringing any medication to school? Yes No
If Yes, please give details: …………………………………………………………..
…………………………………………………………………………………….........
Any other important medical information? …................................................
…………………………………………………………………………………………..
………………………………………………………………………………………………………………………………………………………………………
…………………..

 I / We hereby give permission for any member of school staff who is a Paediatric First Aider to administer emergency medi-
cine, advise or treatment, and to take my child to hospital should the need arise.
 I / We will not hold the school responsible for the implementation of the above.

Full Name of Parent / Guardian: .....................................................................

Signature: ………………………... Date: …………………..........
 OTHER SETTINGS YOUR CHILD HAS ATTENDED
(1) Name of Setting: .........................................................................
Date From: ................................ Date To: ................................

(2) Name of Setting: .........................................................................

Date From: ................................ Date To: ................................

Please bring your child’s Early Years Foundation Stage Progress Tracker and any record of achievements
from your child’s last setting.

PARENT DECLARATION

 I/we confirm that our child will fully toilet trained by the time they are admitted to the Nursery at Oakwood
Primary School. We will supply fully labelled change of clothes so in the event of clothes being soiled they
can be changed.

 I apply for admission of my child to this pre-school and certify that all the above details are correct to the
best of my knowledge. I undertake to honour in full the requirements of my child’s agreed study pro-
gramme, and all Oakwood Early Years Rules, Regulations & Policies.

 I have returned this completed form with a copy of my child’s birth certificate to reserve a place for my child.

 I agree that if my child’s hours exceed their entitled funded hours, to pay for any additional hours by the end
of the half term at the rate of £5.00 for every extra hour. I understand that to retain my child’s place, fees re-
main payable even if the child is absent. I acknowledge and agree that all monies paid to Oakwood Education
are non-refundable.

 Full Name of Parent / Guardian:.....................................................................

 Signature: ………………………... Date: ………………….........

Please return completed application form to:

OAKWOOD PRIMARY SCHOOL, 117 TENNYSON ROAD, LUTON, BEDFORDSHIRE, LU1 3RR
 Thank you for your co-operation. Please remember to keep us informed of any changes in your circumstances so that records can be updated. All personal
information is kept strictly confidential and will only be passed on in an emergency or official situation

All About Me
Please answer these questions in as much detail as possible. This will help us to get to know your child
and help him or her to settle in quickly.

My name is: …………………………………………………………………………………………….......................

I was born on (DOB): …………………………………………………………………………………………………….

My favourite food is: ………….………………………………………………………………………...................

I don’t like eating and drinking: ……….…………………………………………………………………...........

I am intolerant/ allergic to: ……………………………………………………………...............……………….

I need medication for: …………………………………………………………………………………………….......

I like to have a nap at: …………………………………………………………….......................................

My favourite toy is: ….…………………………………………………………………………………………..........

My favourite story is: ….………………………………………………………………………………………….......

When I’m feeling sad or need a nap I like to: (e.g. have my comforter):……………………….

I live with my: ……………………………………………………………………………………………….................

In my family I have a sister: …..……………………………………………………..……..…………………......

In my family I have a brother: ……………………………………………………….……………..…...………..

I have regularly contact with other adults who do not live in my house for example: aunty, uncle, cousin.
Their names are: ………………………………………………………………………………………………………….

I have a pet and my pet’s name is: …………………………………………………………………………….…

My favourite nursery rhyme/ nasheed is: …………………………………………………..………….…….

I have learned these surahs: …………………………………………………………………………………………

This is what I can do well: …………………………………….………………………………………………………

These are my likes and dislikes: …………………………………………………………………………….…….

This is what I am working on at home with my parents/ carers: …………………………….....

…………………………………………………………………………………………………

I enjoy these physical activities: …………………………………….………………………………...............

Things I might need help with: ……………………………………………………………………………………….
……………………………………………

Please bring in a drawing/ picture/ sample of work that your child has produced at home. This will help us
to understand better the stage of development your child has reached.
 Attendance Form for Nursery
All nursery children are eligible for 15 hours of free nursery education per week beginning on the term
after the 3rd birthday.

Our Nursery offers flexible attendance hours to help accommodate parents’ busy schedules.

Please choose a structure that best suits you below.

Nursery Session Times

Flexible Hours Days Timings Hours attending

Structure per week
1 5 mornings 9.30am-12.30pm (3 hrs inc lunchtime) 15 hrs
2 5 afternoons 12.30-3.30pm (3 hrs, no lunchtime) 15 hrs
3A Full days 9.30am-3.30pm (6 hrs inc. lunchtime)
3B 8.30am-3.30pm (7 hrs inc. lunchtime)

Clarify your chosen hours:

Structure chosen Hours attending

e.g. 1 e.g. 9.30am – 12.30am
Monday
Tuesday
Wednesday
Thursday
Friday
TOTAL HOURS A WEEK =

I understand that these timings can be permanently changed only once during each term. One off daily
changes can be made for appointments or emergencies at the Early Years Manager’s discretion, please give
at least 1 days notice.

I understand that my child is eligible for 15 hours of free nursery education per week.

I understand that there is a fee for attending more than 15 hours a week and that this fee is £5.00 per
extra hour.

I understand that the fee for extra hours is to be paid online via Parent Pay on a half termly basis by the
date indicated on the invoice and that the fee is non-refundable.

I understand that unpaid invoices may result in my child not being able to attend the following term at
Oakwood Nursery.

Children must arrive and depart from Nursery on time. We cannot accommodate very early arrivals and
late departures will incur a £5 fine for every instance.

Parent/ Carer name: …………………………………………………………….

Parent/ Carer signature: …………………………………………………….….

Date: ……………………………………………

30 Hours Entitlement in Nursery

The 30 hours entitlement for free childcare for 3 and 4 year olds in Nursery has been available from September 2017
for working parents.

All children who are 3 and 4 years old will receive 15 hours of free childcare a week. Please read on to see how you
can check if you qualify for the additional 15 hours of free childcare taking you up to 30 hours a week and how to
apply for it.

If you’re a parent of a 3 or 4 year old, you will need to meet the following criteria in order to be eligible for 30 hours
free childcare.

Both parents must be in work, or for single parent families, the sole parent must be at work. ‘In work” is defined as
being in employment (including self-employed) and earning at least the equivalent of 16 hours per week at National
Minimum Wage or National Living Wage.Each parent must earn less than £100,000 per year.

Families will also be eligible if both parents are employed but one parent (or both parents) are:

 temporarily away from the workplace on maternity, paternity, adoption or parental leave
 temporarily away from the workplace on statutory sick pay

Or if:

 one parent is employed and one parent has substantial caring responsibilities based on specific benefits re-
ceived for caring
 one parent is employed and one parent is disabled or incapacitated and in receipt of specific benefits.

As a parent you will be responsible for checking your eligibility online at www.childcarechoices.gov.uk

 You can apply online at www.childcare-support.tax.service.gov.uk

 or by calling 0300 123 4097 (or 0300 129 9232 for Minicom).
If you are eligible for the additional 15 hours, you will receive an eligibility code. You need to bring that, along with
your national insurance number and child’s date of birth, to the Early Years Manager at Oakwood Nursery before
admission. This will enable you to claim the 30 hours of free childcare. All free childcare either 15 or 30 hours will
commence the term after your child becomes 3 years old.

You can choose for your child to attend more than one childcare provider however, you cannot use more than two
sites in one day. You will also be required to reconfirm your eligibility with HMRC every three months.

Please be aware that all extra hours over 15 hours a week or 30 hours a week (if you qualify for the additional 15
hours a week) will be charged at £5 per extra hour. Invoices are sent out every half term and need to be paid by
the date indicated in the invoice. Unpaid invoices may result in your child not being able to attend the following
term at Oakwood Nursery.

I have read and understood the above statement regarding invoices for extra hours attended in Nursery.

Parent signature: ……………………………………………………………….

ELIGIBILITY CODE
NATIONAL INSURANCE NUMBER
NAME OF PARENT
I have claimed the 30 hours a week of free Nursery childcare: