Nursery Application Form

Child's details

First name* Preferred first name Surname*

Child's birth sex*FemaleMale

Date of birth* Child's nationality* Child's address and postcode* Allergies/dietary requirements Proposed calendar month/year of entry*

Parent/Legal guardian details 1

Title* Other title First name* Surname* Parent relationship to child (father, mother, grandparent, guardian etc)* Email address* Phone number* Address and postcode (if different to child's address above) Does this person have parental responsibility for the child named above?*

Parent/Legal guardian details 2

Title Other title First name Surname Parent relationship to child (father, mother, grandparent, guardian etc) Email address Phone number Address and postcode (if different to child's address) Does this person have parental responsibility for the child named above?

Confirmation and further details

How did you hear about our Nursery? Preferred email address for acknowledgment of this form*

Tick here to confirm the information provided on this form is true and correct to the best of your knowledge at the time of submission*I confirm

Please select one of the following*I/we have paid the £50 registration fee to support this applicationI/We have not yet paid the £50 registration fee to accompany this application