Bollin Primary: Nursery Application Form

NURSERY APPLICATION FORM

Applications for admission to the Nursery are carefully considered by the head teacher in consultation with the school governors and foundation stage manager. As it is likely that more applications will be received than there are places available, propriety will be given to children who have particular needs. Copies of the Nursery Admissions Policy are available on request from the school office.

Personal Details (Please complete in block capitals)

Information about your child

Surname:_____________________________________ Other Names:_____________________________

Date of birth:_______________________ Gender:_______________________

Religion:_____________________ Home Language:_________________

Information about your child’s legal parent or guardian

Surname:_________________________________________________________

Other Names:_____________________________________________________

Relationship to child:______________________________________________

Home Address:______________________________________________________________________________

___________________________________________________________Postcode ________________________

Telephone Numbers (Home) :________________________________________

(Mobile):________________________________________

(Work):_________________________________________

Names of Siblings	Date of Birth	School/Nursery attending if appropriate

Reasons for requesting a nursery place.

Please give the reasons for requesting a Nursery place for your child.

Educational (e.g. any difficulties your child experiences, for example language development)

________________________________________________________________________________________________

Social (e.g. the extent to which your child has contact with other children)

________________________________________________________________________________________________

Family (e.g. the extent to which any members of the family are under stress, for example one parent families, illness etc.)

________________________________________________________________________________________________

Medical (e.g. any medical conditions your child has)

________________________________________________________________________________________________

Special Educational Needs (e.g. Special educational needs which your child has, for example physical development, lack of co-ordination etc.)

_____________________________________________________________________________________________

Any other relevant information

_____________________________________________________________________________________________

Other Information

(Please circle your answer and complete additional information when required)

Is your child presently receiving any nursery provision or attending a playgroup?

Yes / No

If yes please state the name of the nursery/playgroup and the amount of time they spend there.

_______________________________________________________________________________________________

Have you applied for a Nursery place at any other school?

Yes / No

If yes please state the name of the school.

______________________________________________________________________________

Would you prefer your child to attend a morning Nursery session (08.45 am to 11.45 am) or an afternoon session (12.15 pm to 3.15 pm)

___________________________________________________________________________

Do you wish your child to attend The Bollin when he/she reaches statutory school age?

Yes / No

If no please state the name of your preferred school.

______________________________________________________________________________

Signed :___________________________________________ (Legal Parent/Guardian)

Date:____________________________

Thank you for completing the Application Form. We will contact you around the end of March to let you know if we are able to offer your child a Nursery place. Please let us know if any contact details change.