Pre-School application Form

September 2025 V1.0. Balderstone Nursery and Pre-school forr
Lancashire County Council Early Education Funding (EEF) Parental Agreement
Step 1- Placement details - provider to complete

Step 1 - Placement details - provider to complete

Rows	Balderstone St Leonard's CE Primary school
Ofsted registration number:
EEF start date:

Step 2: Your child's details - parents/carers to complete
Child's Forename(s):
Child Surname(s):
Name by which the child is known (if different from above):
Address:
Date of Birth:

MonthDayYear
Date
Gender:
Ethnicity:
Does your child receive Disability Living Allowance as the provider will be able to claim the Disability Access Funding?:
Step 3: Parent/carer details - parents/carers to complete
Parent / Carer 1
Surname:
Forename:
Date of Birth:

MonthDayYear
Date
National Insurance number or Asylum Support Reference Number (previously NASS):
Parent / Carer 2
Surname:
Forename:
Date of Birth:

MonthDayYear
Date
National Insurance number or Asylum Support Reference Number (previously NASS):
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Step 4: Document check - provider to complete
Documentary proof of DOB Type (e.g. birth certificate, passport):
Proof of DOB seen by (name of staff member):
Date document recorded:
Working parent eligibility code: (if applicable e.g. 12345678912):
2 year old golden ticket voucher code (if applicable):
Step 5: Setting and attendance details - parents/carers to complete with provider
You need to agree and complete this declaration form with each setting your child attends for their funded entitlement to ensure that funding is paid fairly to each of them. Your provider should help you to complete this section.
Is Balderstone the only nursery/pre-school setting your child will be attending? (please circle)

Is Balderstone the only nursery/pre-school setting your child will be attending? (please circle)

Rows	Mon	Tues	Wed	Thurs	Fri	Total no. of hours per week	Total weekly charge	No. of weeks per year (e.g. 38,48,51,52)	Total funded hours per year
2YO golden ticket or 3/4YO universal funded hours per day (total of 15 hours per week)
Working parent's funded hours per day (30 hours a week)
Additional chargeable hours per day charged at £7.00 per hour for 3/4 year olds, £7.50 per hour for 2 year olds
Total Hours per day

Your child can attend a maximum of two settings in a single day. If you are splitting your funded entitlement across more than one setting, please complete the table below:

Your child can attend a maximum of two settings in a single day. If you are splitting your funded entitlement across more than one setting, please complete the table below:

Rows	Mon	Tues	Wed	Thurs	Fri	Total no. of funded hours per week
Setting name/address: Balderstone St Leonard's CE Primary and Pre-school Commons Lane, Balderstone, Blackburn BB2 7LL
Setting name/address:

Note: the maximum number of funded hours your child can receive across all providers is:
- 2 year old families receiving additional forms of support (i.e. 2YO golden ticket): a maximum of 15 hours a week/570 hours per year
- Working families with children aged from 9 months to 4 years old: a maximum of 30 hours a week/1140 hours per year.
- All 3 and 4 years old (i.e. universal funding): 15 hours a week/570 hours per year
Disability Access Funding (DAF)
If your child is splitting their entitlement across more than one setting and is in receipt of DLA please nominate the setting that you want to claim the DAF.
Name of provider nominated to receive DAF
Step 6: Additional Charges - provider and parent to complete
Government funding is intended to deliver 15 or 30 hours a week of free, high quality, flexible early education and care. The 15 or 30 hours must be able to be accessed free of charge to parents, i.e. there must not be any mandatory charges for parents in relation to the early education funded entitlement hours.
Government funding is not intended to cover the costs of meals, other consumables, additional hours or additional services. Providers can charge for consumables, meals and snacks, extra activities and additional hours provided they are not mandatory charges or a condition of accessing a place.
The costs of chargeable extras should be published on provider websites or, where they do not have any website, on local authority Family Information Services. These should be clear, up-to-date and easily accessible to parents, to enable parents to make an informed choice of provider.
Bunny Bundle - £3 per week covers the children's breakfast club offer from 8am every day, snacks and also any consumables (not including nappies, wipes, creams). The Bunny Bundle is purchased through ParentMail on a termly basis by selecting Bunny Bundle option.
I understand that the school will make LUNCH available for my child and this will incur a reasonable charge of £2 a day. Please refer to the school meals payment policy on the website.
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Parents can provide their child with a healthy/no nut packed lunch. At least a week's notice needs to be given to make changes to lunch provision please as we pre-order our food.

Rows	Mon	Tues	Wed	Thurs	Fri	Total weekly charge £
Meals (£2 day school dinner)
Non-food consumables (£3 a week Bunny Bundle)
Additional/enhanced activities (School trips organised throughout the year)

Step 7: Notice period – provider to complete
I am entitled to reduce the number of funded hours outlined in this agreement or move my child from the above-named childcare provider to a new childcare provider, providing I give the childcare provider at least
4 weeks written notice.
I understand there will be no transfer of funding within the term unless written notice has been given by the deadlines specified in section 3 of Appendix 1 - Parental Agreement Terms and Conditions of Early Education Funded Places.
Step 8: Parent/Carer/Guardian with legal responsibility declaration
I confirm that the information I have provided above is accurate and true and I agree to the conditions set out in this document
I authorise the provider named in this agreement to claim the early education funded entitlements as agreed above on behalf of my child. I understand that the data collected in this form will be shared with my chosen provider and local authority.
I give consent for the information contained within this agreement to be used by Lancashire County Council for the purposes of checking my eligibility for all elements of the early education funded entitlements (i.e. working families entitlements, 2 year old entitlements for families receiving Governmentsupport, Early Years Pupil Premium and Disability Access Fund (if applicable), in accordance with its statutory functions under the Childcare Acts 2006 and 2016, and the School Standards and Framework Act 1998.
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I confirm the childcare provider named in this agreement has provided me with a copy of the terms and conditions of funding (Appendix 1) and that I understand these.

Rows	Childcare provider
Print name:
Date:

Signed:
Data Protection
The Data Protection Act 2018 (the Act) puts in place certain safeguards regarding the use of personal data by organisations, including the Department for Education, local authorities, schools and other early education providers. The Act gives rights to those about whom data is held (known as data subjects), such as pupils, their parents and teachers. This includes:
- The right to know the types of data being held, why it is being held; and to whom it may be disclosed
Should you have any concerns relating to how your information or the information relating to your child/ren is being or will be used, please contact your provider or Lancashire County Council. Please note that information about whether a child is in receipt of Disability Living Allowance is, under the Act, Special Category Data which should be handled appropriately.Providers are asked to pay particular note to advice from the Information Commissioner's Office on holding personal data including sensitive personal data available at: https://ico.org.uk/for-organisations/uk-gdpr-guidance-and-resources/training-videos/handling-more-sensitive-information/Privacy Notice: Early Years' Service - Lancashire County Council
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Should be Empty:

Lancashire County Council Early Education Funding (EEF) Parental Agreement

Step 1- Placement details - provider to complete

Step 2: Your child's details - parents/carers to complete

Step 3: Parent/carer details - parents/carers to complete

Step 4: Document check - provider to complete

Step 5: Setting and attendance details - parents/carers to complete with provider

Disability Access Funding (DAF)

Step 6: Additional Charges - provider and parent to complete

Step 7: Notice period – provider to complete

Step 8: Parent/Carer/Guardian with legal responsibility declaration

Data Protection