All Saints CE(A) First School Nursery Enquiry Form

All Saints’ CE(A) First School Nursery Enquiry Form

Child’s Details

Surname: - / Forename: -
Middle Names: - / D.O.B: -
Looked after Child: - YES / NO
Adopted from Care: YES / NO / Male/Female: - / Religion: -
Does your child have any Special Educational Needs: - YES / NO (If so, please explain briefly):
Does your child have an Education, Health and Care Plan (EHCP)?
Names of siblings already at All Saints’ First School (This could affect your position on the waiting list:)
Address: -
Post Code: -
E mail Address: -
Telephone Number: - / Mobile Number: -
Name of current nursery provision (if any): -
Additional Information /Reason for choosing our nursery school: -

Office Use Only

Universal Funding: AM / Universal Funding: PM / 30 Hours Free Childcare: / Paid Childcare: -
Looked after Child : / Social/Medical: / Sibling in School: / Christian Education: -
In Catchment: - / In Parish: - / Distance in Km: -
Date Received: - / Receipt Letter / Email sent: -
Notes: -

Times of Nursery Sessions

At this present time each child is offered a place for five sessions per week, either:
Mornings – 9.15am – 12.15amorAfternoons – 12.15pm – 15.15pm (Funded)
Additional Places are available through the 30 Hours Funded Childcare – 09.15am – 15.15pm (3 & 4 Year Old’s)
All Saints’ First School Nursery accommodates:
Universally Funded15 hours provision (3 and 4 year olds)/ 30 hours funded childcare (3 & 4 Year Olds)
Please note if your child is offered a place in the nursery, it does not guarantee a place in school.
Please return this form to–All Saints’ CE(A) First School, Cheadle Road, Leek, Staffs, ST13 5QY

Note: If you require the 30 hours funded childcare you will be need to register on the Government site -

Nursery Sessions

Please select your required provision here.

We cannot guarantee session availability, but will try our best to accommodate requests.

Universal 15 hours Funded provision:(please circle one choice): - / Morning / Afternoon / Either
Free 30 Hour Free Provision (you will need to qualify, please see below for details):-
The 30 hours of funded childcare is available for families if either both parents are working (or the sole parent is working in a lone-parent family), and each parent earns the equivalent of 16 hours a week at the national minimum or living wage.
To apply you’ll need to register to receive your 30 hour eligibility code with the Government site; / Full Day
Paid Sessions: If you are entitled to 15 hours of funded sessions only, you may pay for additional sessions to provide up to 30 hours of Nursery provision (i.e. up to 5 x 3 hour sessions). Please circle how many sessions you would be interested in. / 1 x 3hr
2 x 3hr
3 x 3hr
4 x 3hr
5 x 3hr

NB: A hot lunch is available from school at a cost of £2.30 per day if children are staying all day. Alternatively, parents may provide a healthy packed lunch.

Signature of Parent/Carer: -
Name of Parent/Carer: - / Date:-

Please note if your child is offered a place in the nursery, it does not guarantee a place in school.

Please return this form toAll Saints’ CE(A) First School, Cheadle Road, Leek, Staffs, ST13 5QY