Application for Starting Nursery 2021/2022

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Please only complete this form if your child's date of birth is between 1 September 2017 and 31 March 2019. Completed forms must be returned to the school by 15 January 2021.

Email *

Child's Details

Child's First Name: *

Child's Last Name: *

Child's Date of Birth: *

YYYY

Gender: *

Male

Female

Child's Address: (This must be the address where the child normally lives. If this is different from the parent/carer address, please give reasons for this. If parents share custody, this must be stated and both addresses shown.) *

Has the child moved in the last 12 months. If yes, please provide previous address:

Parent / Carer Details:

Parent/Carer Title: *

Parent/Carer First Name: *

Parent/Carer Surname: *

Relationship to Child: *

Address (if different from child's address above):

Contact Telephone No.: *

Email Address: *

Do you have Parental Responsibility for this child: *

Yes

Children in Public Care/Looked After Children

Is the child in public care of a Local Authority? *

Yes

Is the child adopted or subject to a residence or special guardianship order? *

Yes

If yes, please state which Local Authority

If yes, please provide a letter from the social worker confirming the legal status of the child and the Local Authority with whom the child is in care.

Sibling Reasons

If there will be a sibling attending the school on the date of your younger child’s admission, please give the details below. If there is more than one sibling, please give the details of all with your application.

Sibling(s) Full Name(s): *

Sibling(s) Date of Birth(s): *

Sibling(s) Year Group(s): *

If you wish to give any other reason for stating your preference, please give details below: *

Requested Provision

Requested provision: *

15 Hours Free Provision (am only - 5 mornings per week)

30 Hours Extended Entitlement

Have you applied or intend to apply to any other nursery provision? *

Yes

Please provide the name of the other provision you intend to apply to:

Declaration and Signature of Parent/Carer

We are committed to protecting your privacy. We will treat any personal information by which you can be identified (i.e. name, address, e-mail etc.) in accordance with the provisions of the Data Protection Act 1998 and GDPR. We will not collect any personal information without your knowledge. This information will be collected for a known purpose that you understand and will not be used in future for any reason other than the one for which it is being collected. We will not sell, trade or rent your information to other third parties.

I certify that:

I wish to apply for a nursery place at Brookfield Primary Academy.

I certify that I am the person with Parental Responsibility for the child named on this form and that the information given is true to the best of my knowledge and belief.

I understand that any false or misleading information given on this form and /or supporting information may render this application invalid, or lead to an offer of a place being withdrawn, and that it is solely my responsibility to provide full information to the school.

I will notify the school of any changes to the details on this form as soon as they occur, especially any change of address, and understand that failure to do so may result in an offer being withdrawn.

I authorise the school to make any checks as they deem necessary. Also, the details of my application and outcome may be shared for health or safeguarding reasons.

I understand that:

Applicants in short term rented accommodation may be asked to provide evidence of their current and former housing arrangements.

Where an applicant has ownership of a property that should be used for the purposes of school admission, and the applicant must provide evidence and reasons for the use of any other address.

Where an applicant rents a property and has ownership of an alternative property, the rented property will only be used for admission purposes if the child has been resident away from the owned property for a period of 18 months or more at the closing date for applications.

Any applicant who moves from a rented or temporary address in advance of their child taking up their school place may have their place withdrawn if it is found the family have returned to an address already in their ownership.

The school will investigate whether the place should be withdrawn if the pupil is not resident at the application address at the time of the September entry point.

Where it is found an address has been used for the purposes of admission where the child is not ordinarily resident, the application and any place offered will be withdrawn.

An offer found to have been gained fraudulently will be withdrawn. This may also be the case where the child has started the school.

In some cases, places may not be withdrawn once a child has been attending the school for a term or more. In these circumstances future sibling applications will not be given sibling priority for places and will be considered under the next appropriate criterion.

Parent/Carer Name (signature) *

Date: *

YYYY

A copy of your responses will be emailed to the address you provided.

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