Nursery Expression of Interest Form 2-4 Years
Child's Name
First Name
Middle Name
Last Name
Child's Date of Birth
Please enter your child's date of birth
Child's Gender
Child's Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please enter what sessions you would like your child to attend
AM
PM
30 hours (3 year plus - working parent code)
30 hours (paying option £95 per week)
2 year old eligibility (Working parent code received)
2 year old eligibility (means tested funding)
If you have a code as above please enter it here
Funding code
Has your child attended any other Nursery - please state
Previous Nursery
What age would you like your child to start Nursery
2
3
4
Medical Information
Asthma, Excema allergies etc
Does your child have any Special Educational Needs?
Full name of mother/guardian
Prefix
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-00000.
Mother's/Guardian Date of Birth
Mother's/Guardian National Insurance Number
Email
example@example.com
Full name of father/guardian
Prefix
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-00000.
Father's/Guardian Date of Birth
Father's/Guardian National Insurance Number
Email
example@example.com
Sibling (already attending Anfield Road Primary School)
Please provide sibling name IF they attend Anfield Road Primary School
Please provide your ethnic origin
Child's country of birth
Language spoken at home
Are you seeking asylum in the UK?
Who has parental responsibility for your child?
Please Select
Mother
Father
Mother and Father
Grandparents
Relatives
Foster Carer
Submit
Should be Empty: