St Luke S Primary School Extended Provision

Endon Hall Nursery

Address: Hillside Avenue, Endon, Staffordshire, ST9 9HH Telephone: 01782 502645 E-mail: [email protected] [email protected] Endon Hall Nursery – Request for place form I wish to request a place in the Nursery for my child.

Child’s name: …..………………………..…. Child’s Date of Birth: ……….………….… Nursery start date: ……….………….

Date my child is due to start Reception*: ………………….…… * This will be the Sept of the academic year in which your child turns 5 years of age

The Nursery sessions required are (tick boxes accordingly): Monday Tuesday Wednesday Thursday Friday

Nursery – Morning session (9am – 12pm) £12 NEF £12 NEF £12 NEF £12 NEF £12 NEF £12 or as part of the 15 funded hours (NEF) (please tick) *Lunch not included Lunch top up (12pm – 1pm) Session School Session School Session School Session School Session School (£4 per session plus £2.10 per lunch provided, if required) lunch lunch lunch lunch lunch (please tick)

Nursery – Full day sessions (9am – 3pm) £24 NEF £24 NEF £24 NEF £24 NEF £24 NEF £24 or as part of the 15 funded hours (NEF) (please tick) * Lunch provided (£2.10 per lunch)

Nursery – Afternoon session (12pm – 3pm) £12 NEF £12 NEF £12 NEF £12 NEF £12 NEF £12 or as part of the 15 funded hours (NEF)

(please tick) In addition, I require childcare earlier or later than the Nursery opening times and wish to request a place for my child in the Phoenix Club. The Phoenix Club sessions required are (tick boxes accordingly): Monday Tuesday Wednesday Thursday Friday Phoenix Club - Before school (7.30am – 8.45am) £5.00 (breakfast included) (please tick) Phoenix Club - After school (3pm – 6pm) £7.00 (snack included) (please tick) Phoenix Club - Full day (7.30am – 6pm) £12.00 (breakfast & snack included) (please tick)

1) My child will be splitting their funded hours between Endon Hall Nursery and another setting: YES / NO (please circle) If ‘Yes’: Which setting? …………………………………………………………………………………… What is the reason for the split placement? ………………………………………………………………………………………………………………………………..

2) I am flexible in the days requested and could accommodate different days based on availability: YES / NO (please circle)

3) My child has a sibling in school: YES / NO (please circle) If yes, sibling’s name/year group: …………………………

4) My child has a sibling in another school: YES / NO (please circle) If yes, which school: …………………………………………….. 5) Do you intend to name Endon Hall as your 1st choice preference when applying for a Reception place? YES / NO

(please circle) Parent/Carer Name: …………………………………………… Parent/Carer Signature: .…………………………….…………… Address: ………………………………………………………………………………………………………………………………………………………………………

Date: ………………………..… Parent/Carer Contact Telephone number: …………………………………………………………

Parent/Carer e-mail address: …………………………………………………………………………………………….……