Form from: Ash Grange Nursery and Primary School

Ash Grange Nursery Application Form

If you would like to request a place for your child complete our online Nursery Application Form. This will be be sent to our admissions officer for review.

Please note that completing this form does not guarantee a place. You will be notified by the school if your child has been allocated a place.

Student Personal Details

Legal Forname

Middle Name

Legal Surname

Known as (if different)

Gender

Date of Birth

Line 1 - Name or House Number

Line 2 - Street

Line 3 - Town

Line 4 - County

Post Code

Parent Carer 1 / 2 Details

Details of Parent / Carer 1 that has legal responsibilities

Please give details below of all persons who have parental responsibility - the parent / carer completing this form must inform the school of any individuals with parental responsibility. (Parental responsibility can only be removed by Court Order - for more information about parental responsibility please visit www.gov.uk/parental-rights-responsibilities .)


Title

Name

Surname

Relationship

Other

Parental Responsibility

Address

Home Number

Mobile Number

Email Address

Place of Work

Job Title

Work Phone Number

Details of Parent / Carer 2 that has legal responsibilities

Title

Name

Surname

Relationship

Other

Parental Responsibility

Please indicate if this is the address that the pupil normally resides (i.e. sole or shared residency) using the tick box

Address

Is there a Court Order in place?

Do they require a School Report

Home Number

Mobile Number

Email Address

Place of Work

Job Title

Work Phone Number

If there is any other person who can be deemed a ‘parent’ (eg. step parent, or parent’s partner) please provide their details below, indicating if they have 'parental responsibility'.

Title

Name

Surname

Address

Relationship (Step Father, Step Mother or parent’s partner)

Parental Responsibility

Mobile Number

Email Address

Other Contacts

OTHER CONTACTS

Before disclosing details below of anyone else you wish to be contacted in an emergency, you must ensure you have obtained consent from the individual(s) concerned.   Please list contacts in order of preference - 1st contact = first preference.

Title

Name

Surname

Home Number

Mobile Number

Relationship to pupil

Do you wish to add an additional contact?

Title

Name

Surname

Home Number

Mobile Number

Relationship to pupil

Do you wish to add an additional contact?

Title

Name

Surname

Home Number

Mobile Number

Relationship to pupil

Brothers / Sisters in this School

Name and the Form of Brothers / Sisters in this School

Name and the Form of Brothers / Sisters in this School

Name and the Form of Brothers / Sisters in this School

Medical Information

Surgery Name and Address

Do you give consent for your child to receive emergency medical treatment?

Any known Medical Conditions? (Epilepsy, Asthmatic) or Allergies?

Any Dietary Needs or Food Allergies? (Please specify e.g. Gluten Free / Coeliac)

Previous School/Setting Details

School Name / Address / telephone number

Ethnic / Cultural Information

National Identity

First Language Spoken at Home?

Ethnicity

Please tick ONE from the following options






Sessions Preferred

What is your preferred Start Date?

Nursery 1 (2Y) has September, January and April Intakes. Nursery 2 (3Y) has only a September intake

My sessions will be

Declaration

Declaration of Person with Legal Responsibility

I wish to apply for a place at the nursery school named overleaf. I certify that I am the person with parental responsibility for the child named above and that the information given is true to the best of my knowledge and belief. I understand that if I give any false or deliberately misleading information on this form and/or supporting documents, or withhold any relevant information, this may lead to the withdrawal of an offer of a nursery place for my child. I understand that it is my responsibility to provide full information to the nursery and that I will notify them of any changes to the details on this form or accompanying evidence as soon as they occur, including any change of address.

Please sign below

signatureplease use your mouse or finger sign above

Personal Information Policy - We respect your rights and are committed to ensure that we protect your details and the information about your dealings with us. In accordance with the Data Protection Act 2018 and the General Data Protection Regulation (GDPR), we will use your information for the purpose of processing your application for a nursery place. We may share your information (but only the minimum amount of information necessary and only where it is lawful to do so) with Surrey County Council and other agencies (including schools, other councils, central government departments, law enforcement agencies, statutory and judicial bodies, contractors that process data on our behalf and medical advisors). We may also use and disclose information that does not identify individuals for research and strategic development purposes. You can find out more about how we manage your data on our website.

Your name

Your email