Tenterfield Nursery School

Tenterfield Nursery School

Application Form for 3 year olds
Child's Full Name*

First NameMiddle NameLast Name
Date of Birth*

DayMonthYear
Gender*

MaleFemale
Your child will be eligible to start Tenterfield the term after their third birthday. We have 3 starting dates throughout the year: September, January and April. Please specify which intake you require.
When would you like your child to start?*

SeptemberJanuaryAprilAs soon as possible (late application)
Child's Permanent Address*

Street Address

Street Address Line 2

CityCounty

Postcode
Parent/Carer Name*

PrefixFirst NameMiddle NameLast Name
Relationship to child*
Is your address the same as your child's?*

YesNo
Parent/Carer's address*

Street Address

Street Address Line 2

CityCounty

Postcode
Telephone number*
Email address*
example@example.com
Does your child have a statement of Special Educational Needs?*

YesNo
Please provide details*
Is your child a ‘child looked after’ by the local authority?*

YesNo
Is your child subject to a Child in Need or Child Protection Plan?*

YesNo
Are there any medical or social reasons to support this application for Tenterfield? (Please provide evidence)*

YesNo
Please provide details*
Does your child have a sibling who is a pupil on roll at Tenterfield? (when this child is due to start)*

YesNo
To check your eligibility for a 30-hour place, please see the following government website - www.childcarechoices.gov.uk

30 hour places must be taken Monday - Friday, 9am - 3pm with an option of wraparound care should you require it.
Please select how many hours you would like*

15 hours30 hours
Are you eligible for a 30-hour place?*

YesNo
Please provide your 30-hour eligibility code
Do you expect to use all 30 hours at this setting?*

YesNo
Would you like to use our wraparound care?*

YesNo
I confirm that the details above are correct to the best of my knowledge.*

Yes
Signature of parent/carer*

Clear
Date*

DayMonthYear
Date
Should be Empty: