For Office use only
DfE eligibility for 2 year funding
APPLICATION FOR A PLACE AT BALDERSTONE BRAMBLES NURSERY
1. SCHOOL / SETTING REQUIRED
Name of Establishment:
Name of child applying for a place:
Are you applying for a place for a 2-year-old?
Will you be applying for/using your 30 hours working parent offer (government funded hours for 2-year-olds of up to 30 hours available)
Yes
No (chargeable at £7.50 per hour)
What is your 11-digit childcare account code?
What is your National Insurance number associated with the account?
****Please note:
To keep getting free childcare, you must
reconfirm your eligibility
by signing in to your childcare account every 3 months.
*Please note - that in-line with our admission's policy - priority will be given to children wanting full day places.
Morning Sessions 8.40am-12pm
Afternoon Sessions 12pm-3.10pm
Full School Day 8.40am-3.10pm
Wraparound Breakfast from 7.30am
Wraparound After School Provision available until 6pm
2. CHILD DETAILS
Name
First Name
Last Name
Gender
Male
Female
Date of Birth:
-
Month
-
Day
Year
Date
(Please provide evidence of date of birth eg copy of birth certificate)
Back
Next
Child's address:
Postcode:
Child's home language
Is/does the child? - In public care (looked after previously adopted outside of England)
Yes
No
- Known to Children's Integrated Services (Social Worker)
Yes
No
- Statemented for Special Educational Needs / EHC Plan
Yes
No
- Known to the Educational Psychology Service
Yes
No
- Have a disability
Yes
No
- Have an illness
Yes
No
- Have any allergies
Yes
No
(If you tick yes in any box, please note sections 5 and 6 of this form.)
3. SIBLINGS
These are defined as brothers, sisters, half brothers, half sisters, step brothers, step sisters, adopted and fostered children living with the same family at the same address (at the time of admission). Male. Female
Surname
Forename(s)
DoB
-
Month
-
Day
Year
Date
Surname
Forename(s)
DoB
-
Month
-
Day
Year
Date
Surname
Forename(s)
DoB
-
Month
-
Day
Year
Date
*Will any of the siblings be attending Balderstone St Leonard's Primary or Pre-school from September 2025? (Please note that in-line with our admissions policy - children with siblings at Balderstone have priority)
Yes
No
4. PARENTS / CARERS DETAILS
Surname:
Forename(s)
Date of Birth:
-
Month
-
Day
Year
Date
National Insurance number
Address: (if different from child's)
Postcode:
Email
Telephone No
Format: (000) 000-0000.
Mobile
Format: (000) 000-0000.
Back
Next
Surname:
First Name
Last Name
Forename(s)
First Name
Last Name
Date of Birth:
-
Month
-
Day
Year
Date
National insurance number:
Address: (if different from child's)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Postcode:
Email
example@example.com
Telephone No
Format: (000) 000-0000.
Mobile
Format: (000) 000-0000.
5. MEDICAL, SOCIAL OR WELFARE CIRCUMSTANCES OF THE CHILD OR THE FAMILY
(These will be treated in strict confidence)
PLEASE CONTINUE ON A SEPARATE SHEET OR SUBMIT SUPPORTING EVIDENCE IF REQUIRED.
Are there persons/professionals who could support this application? (Please state any information which you think is relevant or attach a written statement if available).
Rows
Name
Designation (eg doctor/health visitor)
Address
Telephone No.
1
2
3
6. GENERAL
Please complete and sign this form and attach any other information which you feel is relevant. You should return it to Balderstone St Leonard's CE Primary school.
7. SIGNATURE(S)
Print Name (in full)
First Name
Last Name
Signed
Date
-
Month
-
Day
Year
Date
I/we acknowledge that the information given on this form is accurate.
The Data Protection Act 2018 and GDPR are laws that are designed to protect and maintain personal identifiable information. When we are in possession of personal information we will protect it and aim to keep service user information safe, abide by the law in respect of handling personally identifiable information, and respect the wishes of service users who do not want us to share their information.
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