Someries Infant School and Early Childhood Education Centre's Free Childcare Entitlements Parental Declaration Form

Please complete this form for ALL of the free early years funded provision your child attends, including provision taken outside Someries Infant School and Early Childhood Education Centre.

Providers include nursery schools, full day-care nurseries, pre-school playgroups and childminders.
Step 1: Your child’s details
Your child's name*

First NameLast Name
Your child's date of birth*

DayMonthYear
Date
Address*

Street Address

Street Address Line 2

CityCounty

Post code
Step 2: Your details

Please note that if your child has only one parent or carer, you do not need to provide details of their second parent or carer
Name of Parent or Carer 1*

First NameLast Name
Date of birth of Parent or Carer 1*

DayMonthYear
Date
National Insurance number or Asylum Support Reference Number (previously NASS) of Parent or Carer 1*
Name of Parent or Carer 2

First NameLast Name
Date of birth of Parent or Carer 2

DayMonthYear
Date
National Insurance number or Asylum Support Reference Number (previously NASS) of Parent or Carer 2
Step 3: Your child’s eligibility
Please tick which entitlement you will be using. If your child is two years old and eligible for both entitlements, you should use the entitlement for children from 2 years old receiving some additional forms of support first.

Entitlement for children from 2 years old in families receiving additional forms of support, including if parents/carers live in England and are in receipt of certain benefits, if a child is looked after by a local authority, has an EHC plan, gets Disability Living Allowance or has left care under an adoption order, special guardianship order or a child arrangements order.Working parent entitlement for children from 9 months old.Universal entitlement for 3- and 4-year-olds.
Disability Access Fund (DAF)

Someries Infant School and Early Childhood Education Centre could receive extra funding for your child if certain criteria are met, please opt in by ticking the below boxes if they apply to you or your child.
The Disability Access Fund (DAF) is used to help providers to make reasonable adjustments in their settings, either to support an individual child, or for the benefit of all children attending the setting. Is your child entitled to the Disability Living Allowance? Ticking yes will enable your chosen provider to receive the DAF.

YesNo
Early Years Pupil Premium (EYPP)

Early Years Pupil Premium (EYPP) is paid to childcare providers to provide extra support for your child. EYPP can be used to improve teaching and learning facilities and resources to impact positively on your child’s progress and development. Ticking yes to the questions may enable your chosen provider to receive the EYPP.
Are you in receipt of Universal Credit?

YesNo
Is your child currently looked after by a local authority/have they ever been looked after by a local authority in England or Wales?

YesNo
Are you an asylum seeker receiving support under Part Six of the Immigration and Asylum Act 1999?

YesNo
Document check

If you are not happy providing these details electronically, please visit our School Office with paper-based versions of these documents where our Business Support Team will be happy to verify these in-person. Failure to provide this documentation will result in your child's Nursery place being revoked.
Please upload documentary proof of Parent or Carer 1's date of birth type (for example, their birth certificate or passport)

Browse Files

Cancelof
Please upload documentary proof of Parent or Carer 2's date of birth type (for example, their birth certificate or passport)

Browse Files

Cancelof
Please provide your working parent eligibility code in the format 12345678912
12345678912
Please provide your 2-year old eligibility code in the format 12345678912
12345678912
Attendance details

You need to agree and complete this declaration form with each setting your child attends for their funded entitlement in order to ensure that funding is paid fairly to each of them. We can help you to complete this section. If you require support completing this section, please contact the school. Your child can attend a maximum of two settings in a single day and if your child attends more than one setting the local authority will distribute the funding appropriately between the settings.
How many funded hours are claimed per week at Someries Infant School and Early Childhood Education Centre?*
Second providers

If your child attends another setting, please complete this section.
Name of second provider
How many funded hours are claimed per week are claimed per week at the second provider?
To note: the maximum number of funded hours your child can receive is:

1) for 2-year-olds in families receiving additional forms of support: 15 hours a week for 38 weeks of the year

2) for children aged from 9 months of eligible working parents:15 hours a week for 38 weeks of the year (this will increase to 30 hours from September 2025). For 3 and 4 years old this can be combined with the below entitlement to a maximum of 30 hours.

3) for all 3 and 4YOs: 15 hours a week for 38 weeks of the year
If your child is splitting their funded entitlement across more than one setting, please nominate their main setting:
Additional charges

This does not include self-funded childcare sessions
Funded early education and optional charges at Someries Nursery
Government funding is provided to deliver 15 or 30 hours per week of free, high-quality, and flexible early education and care. These funded hours must be offered free of charge to parents, with no mandatory fees attached as a condition of access.

However, government funding does not cover the cost of meals, snacks, consumables, additional hours of childcare, or extra activities and services. Providers are permitted to charge for these items, as long as such charges are optional, clearly communicated, and not a requirement for accessing a funded place.

At Someries Nursery, we are fully committed to delivering the 15 or 30 hours of funded childcare in line with statutory requirements. We do not apply any mandatory charges in connection with accessing these funded hours. All optional services are charged separately and are made clear to parents from the outset to support informed decision-making.

Lunch charge
A 30-minute lunch period is included within the 30-hour funded entitlement.

Families who choose for their child to receive a school-provided meal during this time will incur a daily lunch charge of £2.60, which covers the cost of the meal only. This charge is optional, not a condition of accessing a funded place, and is fully in line with government guidance.

Families must select either school meals or packed lunches on a weekly basis. To ensure consistency and effective planning, changes cannot be made during the week.

Extended childcare charge
To support families who require childcare beyond 2.45 p.m., Someries Nursery offers an optional extended childcare service, aligning with the wider school day. This provides an additional 30 minutes of care each day, totalling 2.5 hours per week beyond the 30-hour entitlement.

This extended provision is not covered by government funding and is charged accordingly to cover staffing costs. The extended childcare charge is optional and entirely separate from the lunch charge.

If this service is not taken up, children must be collected promptly at 2.45 p.m. Late collection without prior arrangement will result in the extended childcare charge being automatically added to your Arbor account.

As with lunch arrangements, families must commit to their collection time on a weekly basis, and mid-week changes are not permitted.

Transparency and access
In line with government expectations, all information regarding optional and chargeable extras - including those for meals, extended childcare, intimate care, and consumables - is clearly published, regularly updated, and easily accessible on our school website. This ensures that all families are able to make well-informed decisions when selecting early years provision for their child.

We hope this statement provides clarity on our funding and charging structure and demonstrates our commitment to delivering accessible, high-quality, and flexible early education for every child.
Please indicate the additional lunch charges you pay per day:

Monday lunch charge of £2.60Tuesday lunch charge of £2.60Wednesday lunch charge of £2.60Thursday lunch charge of £2.60Friday lunch charge of £2.60
Please indicate the additional extended childcare charges you pay per day:

Monday extended childcare charge of £3.70Tuesday extended childcare charge of £3.70Wednesday extended childcare charge of £3.70Thursday extended childcare charge of £3.70Friday extended childcare charge of £3.70
Please indicate the additional charges you are likely to incur per day:

Intimate care or nappy charge of £0.75 (per episode)Alternative milk provision charge (provision of lactose-free or soya milk) (per week) of £2.00Breakfast wraparound care session (per day) of £4.10After-school wraparound care session (until 4.30 p.m.) (per day) of£4.20After-school wraparound care session (until 5.30 p.m.) (per day) of £6.20
Please indicate the total additional charges you pay per week (DO NOT INCLUDE ANY SELF-FUNDED CHILDCARE SESSIONS):
Declaration
I confirm that the information I have provided above is accurate and true. I understand and agree to the conditions set out in this document and I authorise Someries Infant School and Early Childhood Education Centre to claim free entitlement funding as agreed above on behalf of my child. I understand that the data collected in this form will be shared with my chosen provider and local authority.

I understand that Luton Council is collecting my data for the purposes of checking your eligibility for the free entitlements, Early Years Pupil Premium (EYPP) or Disability Access Fund (DAF), in accordance with its statutory functions under the Childcare Acts 2006 and 2016, and the School Standards and Framework Act 1998.
Data protection
The Data Protection Act 2018 (the Act) puts in place certain safeguards regarding the use of personal data by organisations, including the Department for Education, local authorities, schools and other early education providers. The Act gives rights to those about whom data is held (known as data subjects), such as pupils, their parents and teachers. This includes:
- The right to know the types of data being held
- Why it is being held; and
- To whom it may be disclosed
Should you have any concerns relating to how your information or the information relating to your child/ren is being or will be used, please contact your provider or Luton Council.
Name of person completing this form*

First NameLast Name
Email address of person completing this form*
example@example.com
Should be Empty:

Step 1: Your child’s details

Step 2: Your details

Step 3: Your child’s eligibility

Disability Access Fund (DAF)

Early Years Pupil Premium (EYPP)

Document check

Attendance details

Second providers

Additional charges

Declaration

Data protection