LB2 - Bassett - Application to Join

LB2 - Bassett

425 Winchester Road, Southampton, SO16 7DE - Tel: 07982 175170
Email: admin@littleberriespreschool.co.uk
www.littleberriespreschool.co.uk

Child's Forename*

Child's Surname*

Child's Date of Birth*

DayMonthYear

Child's Gender*

Child's Full Address & Postcode*

Parent / Carer Details*

	Parent / Carer 1	Parent / Carer 2
Full Name
Relationship to child
Date of Birth
National Insurance Number
Daytime Telephone Number
Email Address
Postal Address

SESSION REQUEST - Preferred Start Date*

DayMonthYear

Term Time / Holiday Club*

Normal applications are processed on a basis of 4 children to 1 adult for 2 year olds and 8 children to 1 adult for 3 year olds. It is important that we are aware of any additional needs that your child may have prior to making an offer of a place at the pre-school. Please indicate below if your child requires 1 to 1 support due to their needs to ensure they are added to the correct waiting list.*

If you have indicated that your child needs 1 to 1 support, please provide further information here

Please tick the sessions you would like your child to attend (ONLY SELECT ONE OPTION PER DAY):*

	Morning (9am to 12pm)	Afternoon (12pm to 3pm)	Pre-school Day (9am to 3pm)
Monday
Tuesday
Wednesday
Thursday
Friday

Is your child eligible for two-year-old funding?*

If known, please provide your 2-year-old funding reference number:

Please indicate whether you would like the pre-school to check your child's eligibility for 2-year-old funding.

This application places your child on our waiting list. We will contact you as soon as a suitable place comes available. Please note that completion of this form does not guarantee a place for your child. Once your child is offered a place and you accept it, on admission, further personal information and family details are required for our records. Your child's birth certificate is required at this point with a copy made for our file.

If you find that you no longer need the place, please inform us as soon as possible. Should you decide you no longer need the place, we will not retain the details on this application form (please see our Privacy Notice).

Please be advised that this application form and offer of a place is subject to our terms and conditions provided to you.

You can check whether your child is eligible for two-year-old funding via the Southampton City Council website https://www.southampton.gov.uk/schools-learning/pre-school/2-year-olds

Signed

First NameLast Name

Date

DayMonthYear