Application Form Personal details
First name(s) of child:
Surname of child:	Date of birth:
Full address:
Postcode:
Parent/carer name (1):
Relationship to child:
Full address (if different):
Postcode:
Daytime/work tel:	Home:	Mobile:
Parent/carer name (2):
Relationship to child:
Full address (if different):
Postcode:
Daytime/work tel:	Home:	Mobile:

Session request
Preferred start date:
Please tick the sessions you would like your child to attend:
Monday	Tuesday	Wednesday	Thursday	Friday
Morning: 9.00am - Noon
Lunch: Noon – 1.00pm
Afternoon: 1.00pm – 4.00pm
This application places your child on our waiting list. We will contact approx. 6 weeks before your preferred start date. Please note that completion of this form does not guarantee a place for your child, Once your child is offered a place and you accept it, on admission further personal information and family details are required for our records. Your child’s birth certificate is required at this point with a copy made for our file. If you find that you no longer need the place, please inform us as soon as possible. Should you decide you no longer need the place we will not retain the details on this application form (see our Privacy Notice).
Signed parent/carer (1):	Date:
Signed parent/carer (2):	Date:
Please be advised that this application form and offer of a place is subject to our terms and conditions as stated above. By signing this document, you acknowledge that you have read, understood and agree to these terms and conditions.
For office use only:

Date Received:

Notes: