Community Primary School and Pre-School
Beeches Road West Row Bury St Edmunds Suffolk IP28 8NY
Telephone:
Community Primary School: 01638 715680
West Row Pre-School:01638 428082
E-mail:
Manager: Mrs Suzanne Harrison.
Chair of Trustees: Mrs KarysMatthams
Please provide evidence of child’s date of birth e.g. Birth certificate / passport. £20.00 registration (Registration payable if using more than your 15hrs free entitlement).
Application for Pre-school
Child’s Surname ______Forename(s) ______
Date of Birth (day) ______(month) ______(year) ______
Address ______
______
Parent/ Carername______Address (if different from child)______
Place of work/department ______
Telephone Numbers (home)______Mobile ______
(work) ______(email address) ______
Does this person have parental responsibility yes / no
If no please state reason
Parent/ Carer name ______
Address (if different from child)______
Place of work/department ______
Telephone Numbers (home)______Mobile ______
(Work) ______(email address) ______
Does this person have parental responsibility yes / no?
If no please state reason
Do you require information regarding your child to be sent to a non residential parent (parents who do not live with your child but have parental responsibility) yes / no
Emergency contact details
We will always try to contact parents before using their emergency contacts
- Name------
Contact number------
- Name------
Contact number------
Persons authorised to collect child (must be over 16years of age)
- Name------
Number------
Relationship to child------
- Name------
Number------
Relationship to child------
Please provide a photograph of persons for school records.
Personal details of child
Doctor: name and surgery contact details
------Health visitor: name and contact details
------
Does your child suffer from any known medical conditions or allergies, or have any special dietary needs or preferences? Yes / no. If yes give details below
If yes, has a health care plan and agreement to administer medication, if required, been completed yes / no
Does your child have any special needs or disabilities yes / no?
If yes please give brief description below
Do you give us permission to seek advice from outside agencies to enable us to support your child’s developmental needs? This may require observations of your child. Yes / no
How would you describe your ethnicity or cultural background (please see operational file in foyer)
What is the main religion of your family? ------
What language is spoken at home? ------
If English is not the main language at home, will this be your child’s first experience of being in an English speaking environment? Yes / no
If yes we will agree a settling in strategy between yourself and your child’s key person.
Pre-School sessions
Please complete the box below by selecting the sessions with a tick or cross that you wish your child to attend every week. Please note selected sessions may not be available.
Preferred start date (to be agreed with the setting manager) ------
8.45 -11.45am / 11.45 – 12.30pm -£3.00Hot lunch - £2.30 / 12.30 – 3.30pm
£10.80 / £10.80
Mon
Tue
Wed
Thurs
Fri
Note: Children are eligible for 15 hours early years grant funding the term after theirthird birthday. Extra sessions may be available at the rate of £10.80per session.
Two year old funding may be available dependant on family circumstances. Please speak to the manager if you think your child is eligible.
Additional sessions must be paid for regardless of your child’s attendance.
Places will be allocated on birth date order. Children who are in receipt of Early Years funding will be given priority.
For families that are employed by the military, it would be helpful to us to know how long your child will be enrolled in our education system.
Duration of deployment------
Signed ...... Date......