Application Form Nursery 3 & 4 Year Olds

Please complete all fields marked (*)

Your first name *

Your last name *

Your email *

Child's first name *

Child's middle name

Child's surname *

Child's date of birth *

Gender *

Child's home address, including postcode *

Does your child have a sibling at Arlesdene

Previous setting attended by your child

Sessions required *

Mornings Mon - Fri 9am -12pm

30 Hours Mon - Fri 9am - 3pm

Parent/Carer 1 full name *

Full Name

Date of birth *

Parent/Carer 1 National insurance number *

Relationship to child

Mother / Father / Carer

Parental responsibility* *

Is your address the same as the child's *

Your telephone number *

email address *

Parent/Carer 2 full name

Full Name

Date of birth

Parent/Carer 2 National insurance number

Relationship to child

Parental responsibility*

Is your address the same as the child's

Your telephone number

email address

Name of other person authorised to collect your child *

Relationship to child *

Telephone number *

Password *

Medical Information: Child's NHS number *

Please enter a valid number

Doctors surgery and address *

Doctors telephone number

Name of Health Visitor

Has your child ever been stung by a bee or a wasp *

Does your child have any health or medical conditions including allergies *

Treatment

Details including any medication taken regularly

In the event your child has an accident or is taken seriously ill at school you give permission for staff at Arlesdene to seek further medical advice or treatment *

Does your child have any special dietary needs *

Do you have any developmental concerns about your child *

Does your child have an Educational Health Care Plan or an Individual Education Plan *

Are there any other professionals working with you to support your child, or to support your family *

Is your child in receipt of DLA Disability Living Allowance *

Is your child or a sibling of your child the subject of a Child Protection Plan, Child in Need plan or do they have a social worker *

Is your child looked after or have they previously been looked after *

Is your child adopted or under special guardianship *

Ethnicity & Culture ethnic background

First language of child *

Does your child speak English *

Does your child understand English *

Does your child hear any other languages in your family *

Religion

I give permission for my child to be photographed and filmed on video for their In the moment planning , any annual group or individual photos and nursery displays. *

I give permission for my child to be photographed and filmed on video for publications on our website, Facebook and press articles. Children's names are never used. In the moment planning , any annual group or individual photos and nursery displays. *

I am willing for my child to join outings organised by the school e.g a short walk, visit to local shops *

Do you have any concerns about your child starting school (for example , speech and language) *

Have you or your family had any recent changes to your family life for example, new baby, moved house or home circumstances *

We use a service called Arbor to send message by email or text. I give consent for Arlesdene to register my email address and mobile number with Arbor *

I confirm that the details above are correct to the best of my knowledge *

I have agreed with our School's Parent Privacy Policy *