St. Mary's Pre-School Application Form

Full Name of Child*

First NameLast Name

Childs Date of Birth*

Date

Home Address and Postcode*

Parent/Carer Full Name (1)*

First NameLast Name

Relationship to Child

Any Additional information you wish to share:

YesNo

Name

First NameLast Name

Email Address*

example@gmail.com

Home/Mobile Telephone Number

Parent/Carer Full Name (2)

First NameLast Name

Relationship to Child

Home Address (If different)

Home/Mobile Telephone Number

Email Address

example@gmail.com

As soon as possibleWhen they are 3 years oldWhen they are 2 years old

Date application submitted

Date

Please refer to www.childcarechoices.gov.uk to see what funding you're entitled to.