Application Form

If you wish to apply for a nursery place in a Cambridgeshire nursery class or school, please complete and return this form to the nursery by the relevant deadline (available in this year's nursery policy). Please complete a separate form for each nursery you are applying to.

NOTES

A copy of your child’s birth certificate and proof of your home address should be submitted with this form.

Admission to a particular primary school is not determined by attendance at a particular nursery.

The Local Authority (LA) works closely with nurseries to ensure that information received is correct. Any parent giving incorrect information is liable to have the offer of the place withdrawn.

1. YOUR CHILD

Family Name: ………………………………… First Name(s):…………………………............….…

Home Address: ……………………………………..............................................................................

....................................................................................Post Code: ......................................

Nationality ………………………… Male:....... Female:...... Date of Birth: ..........................................

Is the child Looked After (ie in the care of a local authority/fostered)? ............. YES/NO

Does your child have any of the following:

Special Educational Needs (as identified by a relevant education professional)? YES/NO

A severe and long-term medical need?………………..……………………………. YES/NO

If you have answered yes to either of the above, you must provide further information on the back of this form or on a separate sheet, together with copies of all relevant supporting documentation. You should also provide contact details of the relevant professional(s), e.g. your child’s medical consultant or paediatrician, whom we will contact for additional information.

The LEA will, taking specialist advice, determine whether a medical or educational need is exceptional and therefore whether the child should be admitted under criterion 1 of the nursery admission criteria.

2. ADMISSIONS APPLICATIONS FROM OUTSIDE THE UK

Date of arrival in the UK: ………………………………………..……………………………………..

Length of stay In the UK: ……………………………………………………………………………….

Reason for being in the UK: ………...………………………………………………………………….

...................................................................................................................................................

You will need to provide confirmation that the child is yours and that he or she is entitled to education in this country. Please attach a photocopy of your child’s passport and entry visa.

3. YOUR DETAILS

Title: Mr/Mrs/Miss/Ms/Dr Initials: ……… Surname: ..........................................................

Signature: ………………………………............. Date: ..............................................................

Relationship to child: ………………………………………………………………………………

Address (if different from section 1): ……………………………………………….……………………………........……………..………

........................................................... Postcode: ………………………………..…………....

Home Telephone No ………………..... Other Contact/Mobile No ………………...………….

Other Adult(s) with Parental Responsibility for the child

(All adults with parental responsibility should sign this form, where possible.)

Title: Mr/Mrs/Miss/Ms/Dr Initials: ……… Surname: ...................................................

Signature: …………………………………… Date: ……………………………....………...…

Relationship to child: …………………………………………………………………...……………

Address (if different from above): ………………………………………………………………………..…………………………………

.....................................………………… Postcode: …………………………………………..

4. YOUR PREFERENCE FOR A NURSERY

I wish my child to attend ............................................................... Nursery. This is my 1st/ 2nd preference nursery. I am also submitting an application form to

...........................................................................................................................................................

Please explain briefly the reasons for your preference for this nursery ...........................................

...........................................................................................................................................................

When would you like your child to start nursery? Please circle the term and state the year:

Summer Term Autumn Term Spring Term Year ....................

How old will your child be when he or she starts nursery? ............. years & ............. months

5. SIBLINGS - If there are other children living in the home who will be attending the nursey when this child starts, please complete this section.

NAME DATE OF BIRTH NURSERY

....................................................... .......................................... .................................................

Please complete and return this form, along with proof of your child’s date of birth and home address to the nursery. The information you provide here will be used by the County Council for the purposes of admissions only. If you have any queries regarding how this information will be used, please contact the Admissions Team, Box ELH1505, Castle Court, Cambridge, CB3 0AP.

Registration of Interest in Wrap Around Provision at

Homerton Children's Centre

There will be an hourly charge of wraparound provision. Please ask for details.

____________________________________________________________________

Breakfast Club – Early Owlets (8.15am – 9am)

I am interested in Breakfast club for ___________________________

on Monday Tuesday Wednesday Thursday Friday each week

____________________________________________________________________

Lunch Club (11.30am – 12.30pm)

I am interested in cooked lunches for ____________________________

on Monday Tuesday Wednesday Thursday Friday each week

_____________________________________________________________________

Lunch and Afternoon Owlets Session (12.30 - 3.15 pm)

I am interested in the lunch and afternoon owlets session for ____________________________

on Monday Tuesday Wednesday Thursday Friday each week

_____________________________________________________________________

After School Club – Late Owlets (3.15pm – 5.45pm)

You can book for the whole session or parts of this session.

I am interested in After School Club for __________________________

on Monday Tuesday Wednesday Thursday Friday each week

______________________________________________________________________

Holiday Clubs – (Homerton Nursery School is term time only. Holiday clubs will run from 9am – 5pm during school holidays).

I am interested in Holiday Clubs for ____________________________ in

Autumn half term, Christmas, Spring half term, Easter, Summer

______________________________________________________________________

Registration of interest does not guarantee a place

Owlets Sessions & Prices

Prices effective from June 2007

Time	Session	Cost per day	Weekly Cost
11.30am – 12.30pm	Lunch	£3.50	£17.50
11.30am – 3.10pm	Lunch & Afternoon session	£12.25	£61.25
11.30am – 4.45pm	Lunch & Afternoon session and Owlets	£17.50	£87.50
11.30am – 5.45pm	Lunch & Afternoon session and Owlets	£21.00	£105.00
3.10pm – 4.45pm	Late Owlets	£5.25	£26.25
3.10pm – 5.45pm	Late Owlets	£8.75	£43.75