HHDN Nursery Application Form

Helping Hands Day Nursery Application
Child's Full Name

First NameLast Name
Primary Emergency Contact Number
Please enter a valid phone number.Format: 000 00000000.
Child's Date of Birth

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate of Birth
Child's Gender
We’ll need your child’s original birth certificate so we can photocopy it for any nursery education funding application.
Birth certificate, immunisation records or any other relevant documents

PDF, JPG, PNG, or DOC files
Cancelof
Home Address

Street Address

Street Address Line 2

CityCounty

Post Code

Parent / Carer Details

All sections must be completed. If something does not apply, please write N/A - without the necessary information you may not be authorised to collect the child.
Parent / Carer 1

First NameLast Name
Home Address

Street Address

Street Address Line 2

CityCounty

Post Code
Relationship to the child
Home Phone Number
Please enter a valid phone number.Format: (000)00000000.
Work Phone Number
Please enter a valid phone number.Format: (000) 00000000.
Mobile Phone Number
Please enter a valid phone number.Format: (000) 00000000.
Email.
example@example.com
Parent or Carer 2

First NameLast Name
Address

Street Address

Street Address Line 2

CityCounty

Post Code
Relationship to child
Home Phone Number
Please enter a valid phone number.Format: (000)00000000.
Work Phone Number
Please enter a valid phone number.Format: (000) 00000000.
Mobile Phone Number
Please enter a valid phone number.Format: (000) 00000000.
Email
example@example.com
Starting Date Required

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Does your child receive DLA:
Please state your ethnicity
Funding code
National Insurance No. (Parent who claimed funding code)
Date of Birth (Parent who claimed funding code)

DayMonthYear
2 digit day, 2 digit month, 4 digit year

Sessions required (subject to availability)
Please tell us your preferred days/times and we will endeavour to accommodate you
days/times
Is there any additional information we need to know about your child e.g. important likes, dislikes, cultural needs etc?
What other languages does your child speak at home?
Emergency contact with authority to pick up child

(in the event of the parent or carer being unavailable)
Name of person

First NameLast Name
Relationship to Child
Contact Address

Street Address

Street Address Line 2

CityCounty

Post Code
Home Phone Number
Please enter a valid phone number.Format: (000) 00000000.
Work Phone Number
Please enter a valid phone number.Format: (000) 00000000.
Mobile Phone Number
Please enter a valid phone number.Format: (000) 00000000.
Email
example@example.com

We will only use your (including your child's name) personal information to provide a childcare service to you and we would like to keep sending you information so you can receive important updates about our nursery. We will keep your information secure and will never share it except if required to do so by law.
By ticking the yes box, you are consenting to us continuing to hold and processing your data and sending you information. You can of course unsubscribe / ask us not to contact you by email/phone etc at any time
I have read and understood the information regarding the collection and use of information and data by Helping Hands Day Nursery.

I understand that this is a legally binding contract. This contract must be signed by all parties who have parental responsibilities for the child.
Name (parent / carer 1)

First NameLast Name
Relationship to Child
Relationship
Signature
Name (parent / carer 2)

First NameLast Name
Relationship to Child
Relationship
Signature
Please note: NO alterations can be made to this application form without the WRITTEN authorisation of the above signatories.

We do not have the right to withhold information from either parent without written evidence of legal intervention.
Should be Empty:

Helping Hands Day Nursery Application