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More information

Child's details

Name

First name

Last name

Gender

Female

Male

Age

Date of birth

Address

Address line 1

Address line 2

Town

Postcode

Mother or carer's full name

Father or carer's full name

Mobile phone

Home phone

Email

Preferred times

Monday

Full day (8am to 6pm)

Morning (8am to 12:50pm)

Afternoon (1:10pm to 6pm)

Term time - Morning (9am to 12pm)

Term time - Afternoon (1pm to 4pm)

Tuesday

Full day (8am to 6pm)

Morning (8am to 12:50pm)

Afternoon (1:10pm to 6pm)

Term time - Morning (9am to 12pm)

Term time - Afternoon (1pm to 4pm)

Wednesday

Full day (8am to 6pm)

Morning (8am to 12:50pm)

Afternoon (1:10pm to 6pm)

Term time - Morning (9am to 12pm)

Term time - Afternoon (1pm to 4pm)

Thursday

Full day (8am to 6pm)

Morning (8am to 12:50pm)

Afternoon (1:10pm to 6pm)

Term time - Morning (9am to 12pm)

Term time - Afternoon (1pm to 4pm)

Friday

Full day (8am to 6pm)

Morning (8am to 12:50pm)

Afternoon (1:10pm to 6pm)

Term time - Morning (9am to 12pm)

Term time - Afternoon (1pm to 4pm)

Other details

When would you like your child to start?

Are you only interested in free nursery hours (applicable the term following your child's second or third birthday)?

Yes

No

Does your child have a sibling attending the nursery?

Yes

No

Are you a key worker for this borough?

Yes

No

If your child is currently attending another setting, provide the name and address.

Are you claiming childcare tax credit?

Yes

No

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