Application to join.

St Andrews Playgroup Application form                                                 Charity Number: 1026639

07979 092 993

Church Hall,

Watling Street DA1 1RF

Email: standrewsnursery2013@hotmail.co.uk

Personal Details

First name(s) of child:___________________________        Date of birth:________________

Surname of child: ______________________________

Full address: 

___________________________________________________________________________

_____________________________________________       Postcode:_________________

Parent/Carer name (1):__________________________

Relationship to child: ____________________________

Full address (if different): ___________________________________________________________________________

 ______________________________________________    Postcode:_________________

Daytime/Work Tel:___________________ Home:____________________

                            Mobile:__________________

Parent/Carer name (2):__________________________

Relationship to child: ____________________________

Full address (if different): ___________________________________________________________________________

___________________________________________________________________________

                                                                                                           Postcode:_________________

Daytime/Work Tel:___________________ Home:____________________ 

                            Mobile:__________________

Session Request

Preferred start date:_________________

Please tick the sessions you would like your child to attend:

Monday [_] Tuesday[_] Wednesday [_] Thursday [_] Friday [_]

 Are all you child’s Immunizations up to date     Yes[_]   No [_]

This application places your child on our waiting list.

We will contact you as soon as a suitable place becomes available.

Please note that completion of this form does not guarantee a place for your child.

Once your child if offered a place and you accept it, on admission further personal information and family details are required for our records.

Your child’s birth certificate is required at this point with a note of the certificate number made for our file.

If you find that you no longer need this place, please inform us as soon as possible. Should you decide you no longer need the place we will not retain the details on this application form (see our Privacy Notice)

Signed Parent/Carer (1)_______________________ Date:___________________

Signed Parent/Carer (2)_______________________ Date:___________________

Please be advised that this application form and offer of a place is subject to our terms and conditions provided to you. By signing this document, you acknowledge that you have read, understood and agree to these terms and conditions.

How did you hear about our setting ?

Do you know any children that attend our setting ?

Do you know a member of staff outside of the setting? If yes, how?

Please click on the link below to download a copy