St Anne's Infants School Nursery - Application form
Please complete all sections of this form providing up to date, accurate and comprehensive information. Please note that completion of this form is MANDATORY for all children attending St Anne's Infants School Nursery.
Basic Pupil Information
Child's full name
*
First Name
Middle Name
Last Name
Date of birth
*
-
Day
-
Month
Year
Date
Gender
*
Male
Female
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Parents and carers
Parent/Carer 1
Primary Parent/Carer
Name
*
First Name
Last Name
Relationship to child
*
Home address (including postcode)
*
Email
*
example@example.com
Primary contact number
*
-
Area code/first 5 digits
Remainder
Additional contact number
-
Area code/first 5 digits
Remainder
Additional contact number
-
Area code/first 5 digits
Remainder
Contact 1 has parental responsibility and is named on the child's birth certificate?
*
Yes
No
This child is in the care of the local authority?
*
Yes
No
This child has ever been in the care of the local authority?
*
Yes
No
There is a legal (court) order in place relating to this child?
*
Yes
No
Checklist - tick if the answer is YES
This contact has parental responsibility (named on child's birth certificate)
The child lives with this person
This child is in the care of the local authority
This child has ever been in the care of the local authority
There is a legal order in place, relating to this child
Disability Living Allowance is claimed for this child
*
Yes
No
Parent/carer 2
Name
First Name
Last Name
Relationship to child
Home address (including postcode)
Email
example@example.com
Primary contact number
-
Area code/first 5 digits
Remainder
Additional contact number
-
Area code/first 5 digits
Remainder
Additional contact number
-
Area code/first 5 digits
Remainder
Contact 2 has parental responsibility and is named on the child's birth certificate?
*
Yes
No
The child lives with contact 2?
*
Yes
No
Checklist
Yes, this contact has parental responsibility (named on child's birth certificate)
Yes, the child lives with this person
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Transport and medical information
Main method of transport to get to and from school (tick all that apply)
*
Walk
Bicycle / Scooter
Car
Lift/car share
Bus
Other
Please add information of ALL siblings below (click 'Add Row' for each additional sibling) - If siblings are pre-school age, please enter N/A in the final column.
Doctor's surgery information
*
Please Select
Birchwood Medical Practice
Nightingale Valley Surgery
Riverside Surgery
Priory Surgery (Knowle)
Other
If your surgery is not listed, select other above and write the name below
Doctor's surgery contact telephone
*
Is your child up to date with their immunisations?
*
Yes
No
Please list any complications during your child's pregnancy, birth or concerns about your child's development to date: If none, please state this.
*
Does your child have any medical conditions, special needs or disabilities, including allergies?
*
Does your child take any regular medication? If yes give details
*
Are there any other professionals involved with your child? (eg speech and language therapist, social worker, paediatrician etc.) - If yes, give details.
*
Is your child affected by parental or family imprisonment? If yes give details
*
Please tick if your child has any of the following dietary requirements. From term 2 onwards, parents can order and purchase school meals using MCAS (our parent app)
*
Vegetarian
Vegan
Halal
Gluten Allergy
Milk & Dairy Allergy
Tree Nut Allergy
Sulphites Allergy
Mollusc Allergy
Soybean Allergy
Crustacean Allergy
Lupin Allergy
Celery Allergy
Fish Allergy
Mustard Allergy
Peanut Allergy
Egg Allergy
Sesame Allergy
No Dietary Requirements
Other
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Educational Information
If your child has attended a previous nursery or playgroup setting please give details here.
Name of school/nursery
Address, including postcode
Date attended from
-
Day
-
Month
Year
Date
Leaving date (if applicable)
-
Day
-
Month
Year
Date
Is your child on the waiting list for any other nursery?
Yes
No
Please detail any additional educational needs your child has in this box
Does your child have an 'Education Health and Care Plan' or are you in the process of applying for one?
*
Yes
No
Does your child or either parent/carer require specific access arrangements to be made by the school? (if yes, please give details)
*
If allocated a place at St Anne's please indicate which session you would prefer as your first choice (we cannot guarantee this, but will attempt to allocate first choices if possible). For full days a packed lunch or parents will be required to pre-book and pay for a hot lunch.
*
Timetable A - Monday & Tuesday all day, Wednesday AM.
Timetable A+ - As above, but I would like to pay for regular additional sessions (charged at £20 per half day) (subject to availability).
Timetable B - Wednesday PM, Thursday & Friday all day.
Timetable B+ - As above, but I would like to pay for regular additional sessions (charged at £20 per half day) (subject to availability).
Timetable C - Monday to Friday all day (if entitled to 30 hours
If you chose timetable option A+ or B+ from above, please indicate which additional sessions you are interested in your child attending:
Monday AM
Monday PM
Tuesday AM
Tuesday PM
Wednesday AM
Wednesday PM
Thursday AM
Thursday PM
Friday AM
Friday PM
Reason for your choices above (eg working hours, other childcare etc.
*
Please indicate days where you would consider using breakfast club for your child. (Breakfast club is from 8am, and is chargeable on all days):
Monday
Tuesday
Wednesday
Thursday
Friday
Our wraparound care provider can provide after school care for our Nursery children. Please tick all the days (if any) where you would consider using this facility on a regular basis (bearing in mind your choices from above). After school club is chargeable by Munchkins, our provider on all days:
Monday
Tuesday
Wednesday
Thursday
Friday
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Cultural and religious information
Please select your child's religious status from the list below
*
Please Select
Christian
Muslim
Jewish
Hindu
Sikh
Buddhist
None
Prefer not to say
Please select your child's traveller status
*
Gypsy/Roma - housed
Gypsy/Roma - travelling
Occupatonal - travelling
None
Prefer not to say
Other
Please select your child's ethnicity from the drop down below
*
Please Select
White British
White Irish
White Western European
White Eastern European
White Asian
White Other
Black Caribbean
Black Somali
Other Black African
Indian
Pakistani
Bangladeshi
Chinese
Any other black background
Any other Asian background
Any other ethnic background
Mixed white and black African
Mixed white and black Caribbean
Mixed White and Asian
Any other mixed background
Prefer not to say
The first language my child will use is (type answer)
*
Any other languages spoken at home (if none, type none)
*
If English is your child's second language, what is their level of spoken English?
Please Select
Basic
Developing
Good
Excellent
Has your child ever lived in another country? If yes, please give details (including date when they came to the UK).
As most parents are aware, the budgets for nursery schools and classes are especially strained. Each academic term, the school charges £5 for resources for each nursery child (£30 for the full academic year). Please confirm below that you have read this paragraph and are fully aware of the resource charge.
*
I confirm that I am aware of the nursery resource charges and will pay them each term.
Data processing
By clicking submit, you agree for St Anne's Infants school to handle and process the data provided in line with the school's data protection policy, which can be found on the school website.
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