Form from: Clarendon Primary School
CLARENDON PRIMARY SCHOOL NURSERY APPLICATION FORM - SEPT 2023 TO JULY 2024


Please complete this form as fully as possible

1. PUPIL INFORMATION

Child's Full Name

Gender

Date of Birth*

*on acceptance of a nursery place, the school will need to see a photocopy of the birth certificate

FOR WHICH TERM ARE YOU APPLYING FOR A NURSERY PLACE?

You should apply for a nursery place for the term AFTER your child turns 3 (2 if FEET funded). Our main admissions intake is the Autumn Term; however you can also use this form to apply for places starting in Spring or Summer Terms 2024, but these are subject to availability and will be considered as an in-year admission.

Please indicate which Term you are applying for a Nursery place (N.B. generic Surrey Term dates have been used, and may not necessarily be your child's start date.)

How old will your child be on 1/09/2023?

How old will your child be on 02/01/2024?

How old will your child be on 17/04/2023

Years

Months

2. PARENT/GUARDIAN DETAILS

Contact Details

1. Parents Full Name

1. Relationship to Child

1. Address

Postcode

*on acceptance of a nursery place, the school will need to see a photocopy of a household bill from the child's registered address

Distance from school (in miles)

1. Mobile Number

1. Email Address

3. INFORMATION TO HELP US CORRECTLY PROCESS YOUR CHILD'S APPLICATION

Under which criteria are you applying for a nursery placement? (see attached Admissions Arrangements) Please tick as appopriate. Plese note if a box is not selected your child will be prioritised according to admission criteria 5 below.

Please choose the highest admissions criteria relevant to your application

If applying under criteria 3, please enter sibling detail(s)

4. WHICH TYPE OF NURSERY PLACE IS BEING APPLIED FOR?

Please indicate which Nursery place you are applying for

FEET Application No.

Note: Further information on Free Early Education and childcare for two year olds (FEET) can be found on the Surrey County Council website.

5. HOW MANY HOURS ARE YOU APPLYING FOR?

30 HOURS FREE CHILDCARE - Families where both parents are working, or the sole parent is working in a lone parent family, and earning an average weekly minimum wage equivalent to 16 hours at National Minimum or Living wage and less than £100,000 per year could be eligible for 30 hours free childcare.  Further information regarding eligibility and how to apply for 30 hours of free childcare can be found on the Government 's 'Childcare Choices' website: www.childcarechoices.gov.uk.

Are you applying for a 15 hour or 30 hour Nursery place?

The following are available options for nursery sessions at Clarendon Primary School Nursery.  Please state your preference as to which session you would like your child to attend.  Unfortunately preferences cannot be guaranteed as sessions are allocated subject to availability which may result in your child being offered a place at either one of the session options outlined below.

Please note: When making any 15 hour nursery application it will be assumed that this will be funded using the 15 hours of free government funded Early Education ‘universal’ entitlement for 3 & 4 year olds or FEET funding for 2 year olds.

Please enter your preferred 15 hours attendance pattern below -

Please enter how you will be funding your 30 hours.

Please enter your Free Early Education extended entitlement eligibility code here (if known at this stage) PLEASE NOTE - A 2 YEAR OLD FEET CODE IS NOT VALID FOR 30 HOURS

All children who receive the extended free entitlement provision at Clarendon Nursery for 30 hours per week are allocated a core offer of 15 hours which will be reverted to in the event of a child's eligibility for this entitlement ending. At this point in time parents will either have the option to directly fund the additional 15 hours per week themselves (refer to the terms and conditions document) or reduce their child's nursery provision to the core offer of 15 hours. Note: core offer session days will be discussed and agreed at the time any change needs to be made.

If we are unable to offer your child a nursery place for 30 hours, would you like your child to be considered for a nursery place for 15 hours?

If we are unable to offer your child a 30 hour nursery place, please state your preference as to which session you would like your child to attend.

Unfortunately preferences cannot be guaranteed as sessions are allocated subject to availability which may result in your child being offered a place at either one of the session options outlined above.

6. PREVIOUS NURSERY INFORMATION (If applicable)

Has your child previously attended, or are they currently attending another Nursery?

Name of current/previous Nursery

Nursery Address

Nursery Telephone Number

Date started:

Date Ended (Please leave blank if still attending)

7. ADDITIONAL INFORMATION

Does your child have an identified special educational need that will need consideration when your child starts nursery?

Is your child currently in receipt of Disability Living Allowance?

Is your child currently receiving any additional support from any outside agencies?

E.G Speech and Language, pediatrician etc.

Please give further information:

8. OTHER USEFUL INFORMATION YOU FEEL THE NURSERY WOULD FIND RELEVANT AT THIS STAGE

Please enter any other information that you feel is necessary at this time, this is particularly important if you are applying for a place under Criteria 2 – Exceptional Social/Medical Need. (If no relevant details are given, your child will not be considered under this criteria).

9. PARENT/CARER DECLARATION AND SIGNATURE OF PARENT/CARER:

All Applications must be submitted by Friday 24th March 2023, any applications received after this date will be classed as 'Late Applications'.

Once submitted, you will receive, within 7 days, an email confirming that your application has been received.  If you do not receive this confirmation, or you have any further questions regarding the application, please refer to the documentation on our website, or call us on 01784 253379.