APPLICATION FORM FOR REACH UP NURSERY ENTRY IN 2014

Please complete the form to apply for a place for your child in Nursery in 2014. To be eligible for a Nursery place your child’s date of birth must fall between 01/09/2010 and 31/08/2011.

Please use Black Ink and write in BLOCK CAPITALS.

Section 1 / Child’s details(PLEASE COMPLETE ALL PARTS)
a. / Family name/surname
b. / Child’s first & middle name
c. / Child’s sex (tick) / Boy / Girl
d. / Child’s date of birth
e. / Child’s address
f. / Postcode
g. / Confirm this is your child’s principle address
Section 2 / Parent or carer’s details (PLEASE COMPLETE ALL PARTS)
a. / Confirm the details below belong to someone with parental responsibility for the child
b. / Parent or carer’s family name/surname
c. / Parent or carer’s first/given name
d. / Parent or carer’s principle home address (if same as address given in section 1 please write ‘SAME’
e. / Postcode
f. / Preferred telephone number
g. / Email address
h. / Name of sibling(s) at Reach Academy Feltham (if applicable)
i. / Relationship to child / Mother / Father
Step-Parent / Foster-Carer
Other (please state)
Section 3 / Looked after children (PLEASE COMPLETE AS APPLICABLE)
a. / Is the child named in section 1 in the care of a local authority? / Yes / No
b. / If yes, which local authority?
Note / If yes, you must attach a letter from the child’s social worker confirming the legal status of the child named in section 1 and the local authority with which the child is in care.
Section 4 / Ring-fenced places for pupils eligible for Free School Meals (PLEASE COMPLETE AS APPLICABLE)
a. / Would you like your child to be considered for one of our places ring fenced for those eligible for Free School Meals / Yes / No
Note / If yes, you must attach proof that your family is eligible for Free School Meals, for example child tax credits that do not exceed £16,190, or Income Support, or Income-based Jobseekers Allowance. If you are sure if you are eligible, please contact our office on 0203 3551 9305.
Section 5 / Medical or social factors (PLEASE COMPLETE AS APPLICABLE)
a. / Does the child name in section 1 have an acute, established and documented medical or social need which provides a reason why they should be offered a place at Reach Up Nursery?
Yes / No
Note / If yes, parents are responsible for providing supporting evidence from social workers, doctors, health visitors and other professionals of why the need means the child should be given a place at Reach Up Nursery rather than at any other local school. Parents will be responsible for submitting medical evidence and clearly identifying the implications for the child if they were not to be given a place at Reach Up Nursery. In such cases the Governing Body will decide whether this condition applies.
Note / Childcare arrangement and moderate learning difficulties are not considered acute, established and documented medical or social needs.
Section 6 / Submission (PLEASE READ CAREFULLY AND COMPLETE ALL SECTIONS)

Read the following statements carefully, ensure that you understand and have complied with them and tick to confirm.

a. / I have read, understood and agree with Reach Up Nursery’s ‘Admissions Arrangements for 2014’ (available from
b. / I have included any supporting evidence if I have answered ‘yes’ in section 4, 5 or 6.
c. / I have completed all relevant sections of this form and signed the declaration (below).

PLEASE ONLY SEND COPIES OF PAPERWORK AS WE CAN NOT RETURN ANY DOCUMENTS.

Section 7 / Declaration(PLEASE READ CAREFULLY AND SIGN AND DATE)
a. / I wish to apply for a place for my child (named in section 1) at Reach Up Nursery.
b. / I certify that I have parental responsibility for the child named in section 1 and that I am the parent or carer named in section 2 of this form.
c. / I certify that all information given on this form is true to the best of my knowledge and belief.
d. / I understand that providing false or deliberately misleading information on this form and/or supporting paperwork, or withholding any information which the Governing Body deems to be relevant to this application may render this application form invalid and may subsequently lead to the withdrawal of the offer of a place at Reach Up Nursery.
e. / By signing this form I confirm that I have read and understood Reach Up Nursery’s ‘Admissions Arrangements for 2014’ document and agree to all the terms within.
Name (printed) / Name (signed)
Date

All personal information collected herein will be stored in accordance with the Data Protection Act 1998. It will not be passed to any other party except for another lawful purpose. For details on your rights in relation to Data Protection see

Section 8 / Returning the forms to Reach Up Nursery

By post or in person to

Reach Up Nursery

c/o Reach Academy Feltham

Bridge House

Hanworth Road

Feltham

Middlesex

TW13 5AB

BY EMAIL