Application Form

1

Child's InformationPlease fill out with the below questions.

Child's Full Name

Gender

Date of Birth

2

Parent's InformationPlease fill out with the below questions.

Parent's Full Name

Contact Number

Email

Parent's Full Address

Child's Full Address If Different To Above

3

Additional InformationPlease fill out with the below questions.

What language/s does your child speak

Does your child have any additional needs you would like us to be aware of i.e. speech and language, SEND

If yes to the above, is your child eligible for additional funding? This is helpful to know so we can plan for additional one to one support for your child

4

Doctor's Surgery InformationThe name, address and telephone number of the doctor's surgery your child goes to. You may include the name of the GP too if you wish.

Name of Doctor's Surgery

Address of Doctor's Surgery

Phone Number of Doctor's Surgery

Name of GP (Optional)

5

Dentist's Surgery InformationThe name, address and telephone number of the dentist’s surgery your child goes to. You may include the name of the dentist too if you wish.

Name of Dentist's Surgery

Address of Dentist's Surgery

Phone Number of Dentist's Surgery

Name of Dentist (Optional)

6

Emergency Contact InformationPlease fill out with the below questions.

Emergency contact name

Emergency contact number

Emergency contact email

Emergency contact's relationship to child

Emergency contact's full address

7

What date would you like your child to start with us* This field is required.

Date

9

Do you require funding?* This field is required.

YESNO

10

What funding are you eligible for?

11

Parent/parents NI number if applying for a funded space