FREE CHILDCARE FOR TWO YEAR OLDS
Use this form if you are applying for a childcare place that is under additional criteria
Child’s Name: / Date of Birth:Parent’s Name:D.O.B.: / Contact Number:
Address including postcode: / National Insurance Number:
It is recommended that the provider used has a recent Ofsted rating of either Good or Outstanding.
This information can be obtained from any potential provider or can be accessed at A list of participating Providers can be obtained from
Is the child currently attending a provider YES NO Name of provider
Preferred choice of provider if application is successful
Day of the week / Monday / Tuesday / Wednesday / Thursday / FridayHours required for funding
To be completed by parent/carer
I understand that South Gloucestershire Council is under a duty to protect the public funds it administers and to this end may use the information I provide within the Authority for the prevention and detection of fraud. It may also share this information with other bodies administering public funds solely for these purposes. I authorise South Gloucestershire Council to seek confirmation of the validity of the information provided by me on this form from other central and/or local government bodies, as deemed appropriate by the Data Protection Act 1998 having read the Fair Processing Notice on the back of this form. I confirm that the information given on this form is correct and I will inform you immediately of any change in circumstances. I understand that any false or misleading information given on this form or failure to disclose relevant information may make this application void and could render me liable to legal proceedings.
The information on this form may be shared with agencies relevant to this request.
Please indicate if you are registered with your local SureStart centre YES NO
Signature: Name: Date:
Data Statement: Corporate Finance are part of South Gloucestershire Council’s Chief Executive & Corporate Resources Department. We collect names, addresses and d.o.b of children whom we fund for the 2 year old sessions in order to plot take up and geographical spread of need. This scheme is part of a national pilot which is being evaluated. Therefore information about children's progress will be collected for the evaluation and parents will be offered the opportunity to contribute.
The Data Protection Act 1998
Fair Processing Notice
(Schedule 1 Section 2 sub-section 1(a) and Section 3)
Local Authorities (LAs) hold information on pupils in order to manage the system, and in doing so must follow the Data Protection Act 1998. This means, amongst other things, that the data held about pupils will only be used for specific purposes allowed by law. We are therefore writing to tell you about the types of data held, why that data is held, and to whom it may be passed.
The LA uses information collected about pupils to carry out specific functions for which it is legally responsible, such as the assessment of any special educational needs the pupil may have, home to school transport, school admissions, pupil welfare, looked after children, exclusions, early years support etc. Information collected on pupils may also be exchanged with other departments in the Council, and other bodies ( for example, the Local Health Authority) where this is required for statutory purposes or is deemed to be of benefit to the pupil. The LA also uses the information to derive statistics to inform decisions on (for example) the funding of schools, and to assess the performance of schools and set targets for them. The statistics are used in such a way that individual pupils cannot be identified from them.
Information on individuals held on computer systems may be kept up to eight years after they have left school.
Pupils, as data subjects, have certain rights under the Data Protection Act, including a general right of access to personal data held on them, with parents exercising this right on their behalf if they are too young to do themselves. If you wish to access personal data held about your child, please contact South Gloucestershire Council in writing. The Data Protection Officer, South Gloucestershire Council Department for Children, Adults & Health PO Box 298 Complaints & FOI Team Civic Centre High Street Kingswood Bristol BS15 0DR.
FREE CHILDCARE FOR TW0 YEAR OLDS
REFERRAL FORM
Child’s NameName and full address of Referrer ( if applicable) / Contact Telephone Number
Contact Email Address
Please confirm which additional criteria that is applicable:
1. / Looked After Child (to include any time since birth)
Include an adoption certificate, care order or guardianship order
2. / Child on the Child Protection Register
State the name of the Social Worker
3. / Special Educational Needs or Disability (SEND)
Include evidence of the award notice
Please return form and the required documentation to:
2 Year Old Project Officer, Department for Children, Adults and Health
Early Years department
South Gloucestershire Council
PO Box 298
Civic Centre
High Street
BRISTOL
BS15 0DQ
Or alternatively, to your local Childrens Centre, where additional help and support in accessing childcare can be obtained.
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