Nursery Admissions Form / Express of Interest

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Please complete the form below to the best of your ability. Once we have received it, a member of the office team will get in touch with you.

Email *

First name of child *

Surname of child *

Date of birth *

YYYY

Gender *

Name of Parent/Legal Guardian ONE who will receive the ALL TEXTS we send and be the first contact: *

Address of Parent/Legal Guardian ONE *

Home Phone of Parent/Legal Guardian ONE

Mobile Phone of Parent/Legal Guardian ONE *

Email address of Parent/Legal Guardian *

Name of Parent/Legal Guardian TWO

Address of Parent/Legal Guardian TWO

Home Phone of Parent/Legal Guardian TWO

Mobile Phone of Parent/Legal Guardian TWO

Email address of Parent/Legal Guardian TWO

Name and Address of previous school/nursery attended if applicable:

Does your child have any known health condition (s)/Allergies? e.g. Asthma, Eczema, Nuts, Epipen user. If so, please detail below:

Name and Address of your child’s doctor: *

First language of your child *

Main Language spoken at home *

Any other languages spoken at home

Position in Family e.g. 1st Child *

Ethnicity of Child *

Has your family / child been involved with any of the following. (If yes please explain the next box)

Speech Therapist

Education Welfare Office

Social Services

Family Support Services

CAHMS

Court Custody

Other:

If you answered yes to the above question please give details here

Do you need an interpreter *

Please select your preference for your child’s nursery place: *

Please add any further notes here:

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