Baylis Court Nursery School

BAYLIS COURT NURSERY SCHOOL OATLANDS DRIVE, SLOUGH, SL1 3HS. TEL: 01753 521917

APPLICATION FORM

Child’s full name...... Boy / Girl Date of Birth...... ……… Session preferred: Morning Afternoon Either 8.35 to 11.35 12.35 to 3.35 (Circle or tick)

Address...... Post code…………… Home Telephone Number...... Mother’s Name...... Mobile/work Tel. No...... ……….. Mother’s National Insurance Number...... Home Address (if different)...... …………. Email address...... Father’s Name...... Mobile/work Tel. No...... ………... Father’s National Insurance Number...... Home Address (if different)...... ………... Email address...... Parental status (please circle) Married, Separated, Divorced, Single, Co-habiting. Please state who has legal parental rights. Name...... Childminders details (if applicable)...... Emergency Contact: Name/relationship...... Telephone Number...... Ethnic Origin: Child...... Mother……...... Father...... (White, Black-African, Black-Caribbean, Black-Other, Indian, Pakistani, Bangladeshi, Chinese, Any other group). How will you be getting your child to nursery? Walk Car Bus Taxi Date of arrival in the United Kingdom ……………………………...... Do you have Refugee status Yes / No Are you seeking asylum in the UK Yes / No Home Language...... Religion...... Other children in the family:- Brothers/Sisters Name Age/Date of Birth School Attended ...... Infant school child will attend ...... Child’s Doctor - Name...... Tel.No...... Health Visitor - Name...... Tel.No...... Have you been supported by any other agencies for any concerns regarding your child? (General health, speech, eyesight, social services, child guidance).

Please give details...... Does the child have any difficulties as described below? Give details. Allergies / Speech delay / Hearing problems / Asthma / Behaviour / Social problems ………………………………………………………………………………………… Please give any other information which may support us in settling your child or about home/family circumstances which may support grounds for a priority admission...... Is your child on any other nursery school waiting list?...... ……… Which adult will bring and collect your child from school…...... ………... I agree to my child being taken on small outings by qualified staff during school hours; for example, a group visit to a local shop or park. (Parents will be notified separately of any main outings). I agree not to transfer my child to another nursery after a place has been offered, unless I move house and can no longer get here. I understand that if my child does not attend regularly and the place is under used, the the governors may withdraw his/her place.

Signed...... Parent/Guardian Date...... Please bring your child’s birth certificate with you on the day of admission to nursery school.

STAFF USE ONLY

Session offered am / pm

Group Duck/ Frog

Member of staff...... ……

Date admitted...... ……