Ludwick Nursery Application Form
Ludwick Nursery or Tree Tops?
Are you applying for a place at?
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Ludwick Nursery (3-4 years olds)
Tree Tops (2 year olds)
Child's Information
Child's Information
Child's Name
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First Name
Last Name
Gender
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Male
Female
Address
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Telephone Number
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Please enter a valid phone number.
Child's Date of Birth
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Child's Age
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NHS Number
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Funding Codes
Please refer to the government website if you need assistance with your code - https://www.gov.uk/sign-in-childcare-account
Funding Code (If Applicable)
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Does your child have an EHCP?
Yes
No
In the process
Does your child receive DLA?
Yes
No
In the process
Contact information
Parent Information
Parent 1
Parent's Name
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First Name
Last Name
Relationship to Child
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Telephone Number
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Please enter a valid phone number.
Do you live at the same address as your child?
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Yes
No
If no, what is your address?
Email Address
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Date of Birth
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National Insurance Number
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Parent Information
Parent 2
Parent's Name
First Name
Last Name
Relationship to Child
Telephone Number
Please enter a valid phone number.
Do you live at the same address as your child?
Yes
No
If no, what is your address?
Email Address
Date of Birth
National Insurance Number
Emergency Contacts
If you are not available please provide in priority order the names of the people we can contact in an emergency
Name
*
First Name
Last Name
Phone Number
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Please enter a valid phone number.
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Collection Password
Please provide us with a password to be used if your child is collected by anyone other than you
Collection Password
*
Sibling Details
Please list any other children in the family and their relationship to your child
Name
First Name
Last Name
Date of Birth
Relationship to child
Brother
Sister
Name
First Name
Last Name
Date of Birth
Relationship to child
Brother
Sister
Name
First Name
Last Name
Date of Birth
Relationship to child
Brother
Sister
Language, Religion and Ethnic Origin
Is English your child's first language?
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Yes
No
If no, what is your child's first language?
Any other language spoken in the home?
Family Religion
Ethnicity
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Pre Nursery Experience
Where did they attend?
How often did they go?
What age did they start?
Pre Nursery contact name and number
Other Professionals
Other Professionals
Health Visitor, Speech & Language Therapist, Social Worker, etc
Name
First Name
Last Name
Job Title
Agency
Phone Number
Please enter a valid phone number.
Name
First Name
Last Name
Job Title
Agency
Phone Number
Please enter a valid phone number.
Medical
Medical Practice and Address
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Telephone Number
*
Please enter a valid phone number.
Does your child have any medical conditions such as allergies or special dietary needs?
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Yes
No
If yes, please specify
Will your child need special help from a member of staff? Please detail below any special help needed:
Immunisations
Is your child up to date with their immunisations?
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Yes
No
Consent
Photo Consent
Occasionally we take photographs and/or video footage of the children at school. We may use these images in various ways including newsletters, digital displays, publications, websites etc. Sometimes the media may visit the Centre and take photographs or film the children. They may use these images in newspaper articles, websites or printed publications. Images will be stored by the Centre, other centres or the media in archives and may be used up to two years later, after which the images will be destroyed. To comply with the Data Protection Act 1998, we need permission from the child’s parent or guardian before we can photograph or make recordings of any child, or allow any visiting media to do so. To give your consent, please tick the boxes below to clearly indicate in which areas you are happy for your child’s image to be used. Conditions for use of images: 1. This consent is valid for the period of time your child attends Ludwick Nursery School. Images will not be used after this time.2. The images taken will be of activities that show the children and the school in a positive light. 3. Embarrassing or distressing images will not be used. 4. We may use group or class photographs or footage with very general labels e.g. small group activity, sport day 5. We will only use images of children who are suitably dressed.6. We will make every effort to ensure that images are not taken of children for whom permission has not be given, or who are ‘at risk’ or disallowed from being photographed for legal or social reasons.7. We will take all reasonable measure to ensure the images are used solely for the purposes for which they are intended. However, we cannot guarantee this and take no responsibility for the way images are used by other websites or publishers or consequences arising from publication. I give permission for my child’s image to be used for the purposes as mentioned above;
I give my permission for my child's image to be used for the purposes as mentioned above
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Yes
No
School Outings
Occasionally we will take the children out of school (for example, on a short walk to the local shop, a visit to the local Primary School to watch a play, or on a bus ride). We need permission before we are able to do this: Visits: Please sign below to indicate whether you are ALLOWING your child to be taken on short outings with staff. If you do not sign this slip we will not take your child out of the nursery on school outings.
I agree to my child being taken on short outings
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Yes
No
Nursery Sessions
Nursery Sessions
We offer 15 hour or 30 hour sessions. 15 hour sessions are held either in the morning or in the afternoon, Monday to Friday, during term time. Please state your preference, if you have one.
How many hours?
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15
30
Morning or Afternoon
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Morning (8:45am - 11:45am)
Afternoon (12:30pm - 3:30pm)
I don't mind
Privacy Notice
In completing this application form you should refer to our Privacy Notice for Parents/Carers. http://www.ludwick.herts.sch.uk/download/privacy-notice-for-parents-carers-full/ The personal information collected on this form will be processed to manage your application in accordance with this policy. By ticking the box below you agree to us contacting you my email.
I have read and agree with the Privacy Notice for Parents/Carers
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Yes
Declaration
The information I have given on this form is accurate and correct to the best of my knowledge. I understand that my personal information will be held securely and will be used only for local authority purposes. I agree to Ludwick Nursery School using this information to consider my application for a nursery place. I understand that the completion of an application form does not guarantee a place in the nursery class.
I agree with the declaration above
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Yes
Notes to Parents
How the information on this form will be used:By completing this form and signing the declaration you are agreeing for Ludwick Nursery School, if they are oversubscribed, to check whether your child’s details meet the school’s published admissions rules and if he/she can be offered a nursery place. Any personal data collected will be treated as confidential under the principles of the Data Protection Act 2018. We will not use the data for any other purpose, nor will we share your data with any third parties other than the Department for Education (for statutory reporting), Hertfordshire County Council departments who may from time to time send you advise, guidance and information relating to changes to early years provision and educational services that are relevant and/or of benefit to your child and your local children’s centre who support the local authority by assisting families to access the services that children are entitled to.
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