Parental Agreement: Funded Early Years Provision
All parents of eligible 2, 3 and 4 year olds must complete a Parental Agreement for each Early Years childcare provider their child attends. This allows the provider(s) to be paid for the Early Years entitlement of up to 15 or 30 hours. This form is required by the North Yorkshire Early Years Funding Team.
Name of Childcare Provider:
*
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Section 1: Child's Details
Child's Legal Name:
*
First Name
Last Name
Child's Preferred Name(s) (if different from above):
Child's Address:
*
Street Address 1
Street Address 2
Town
County
Postcode
Child's Date of Birth:
*
-
Day
-
Month
Year
Child's Sex:
*
Please Select
Female
Male
Child's Ethnic Background:
Is your child eligible and in receipt of Disability Living Allowance?
*
Please Select
Yes
No
If your child is eligible and in receipt of Disability Living Allowance, please nominate the main early years provider that you wish to claim for the DAF (only applicable if your child attends more than one setting):
Please Select
Stepping Stones Nursery
My child's other setting
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Section 2: Weekly Attendance & Claim Details
Please indicate which type of funded childcare your child is eligible for. For further guidance on Funded Childcare, please visit childcarechoices.gov.uk
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Up to 15 hours of childcare for 2 year olds (Working Family expanded childcare)
Up to 15 hours of childcare for 3 and 4 year olds (Universal childcare)
Up to 30 hours of childcare for 3 and 4 year olds (Working Family expanded childcare)
I'm not sure (Please contact us to discuss)
Please enter the eligibility or voucher code you have been issued to claim Working Families Funded Childcare (this should be an 11-digit eligibility code or a 6-digit voucher code). Please note that if your child is aged 3 or above, and you are ONLY claiming for up to 15 hours of childcare, you do not need to apply for a code.
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For further information, please visit www.childcarechoices.gov.uk
Please enter the TOTAL number of hours your child will attend STEPPING STONES. Please include the total hours, whether this is funded childcare or whether you will be paying for the hours. If you're not sure which days/hours you'd like yet, don't worry. Fill this section in as best as you can and we can change this later if your requirements change.
If your child attends a second childcare setting where they are claiming for Funded Childcare, please indicate how many hours they will be 'using' at their other setting:
What is the name of the other childcare setting that your child attends?
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Section 3: Parents/Carers with Parental Responsibility
This section must be completed to enable us to check and claim (if applicable) for the correct number and type of funded hours.
Parent/Carer 1 Full Name:
*
First Name
Last Name
Parent/Carer 1 Date of Birth:
*
-
Day
-
Month
Year
Date
Parent/Carer 1 National Insurance Number:
*
Please enter your NI number or NASS number if you do not have a NI number
Parent/Carer 2 Full Name:
First Name
Last Name
Parent/Carer 2 Date of Birth:
-
Day
-
Month
Year
Date
Parent/Carer 2 National Insurance Number:
Please enter NI number or NASS number if parent/carer does not have a NI number
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Section 4: Parental Declaration
Please tick to confirm or accept the following:
*
Please upload evidence of your child's date of birth:
*
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Name of Parent/Carer:
*
First Name
Last Name
Parent/Carer Signature:
*
Date of Signature:
*
-
Day
-
Month
Year
Date
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Should be Empty: