HILLSIDE PRIMARY SCHOOL - Nursery

APPLICATION FOR ADMISSION TO

HILLSIDE PRIMARY SCHOOL - Nursery

Child’s Surname: / Child’s First Names:
Date of Birth: / Gender:
Birth Certificate Seen: Y / N / Email address:
Is your child a ‘Looked After’ child?
YES / NO
Is your child Adopted?
YES / NO
Is your child subject to a Child Arrangement Order, Special Guardianship Order (SGO) or Residence Order?
YES / NO / Are your child’s siblings already at Hillside?
YES / NO
What are their names?
This is my catchment school:
YES / NO
Details of Adults with Parental Responsibility:
Main Contact
Name: …………………………………………………………………………. Relationship: ………………………………………
Address: ……………………………………………………………………………………………………………………………………..
……………………………………………………………………………………………………………………………………………………
Post Code: ……………………………………… Contact Phone Number ……………………………………………………
Second Contact
Name: …………………………………………………………………………. Relationship: ………………………………………
Address: ……………………………………………………………………………………………………………………………………..
…………………………………………………………………………………………………………………………………………………….
Post Code: ……………………………………… Contact Phone Number ……………………………………………………
Please indicate your preferred choice:
AM or PM / MON / TUE / WED / THU / FRI / Total hours per week
A)Universal 15 hours a week (3 hours per session)
Please tick as appropriate
B)Extended 15 hours entitlement.
First 15 hours accessed at different placement – please provide name of other setting:
……………………………………………………..
Total Funded Hours Claimed
Per Week (maximum 15 hours)

The above information is true to the best of my knowledge and belief. I understand that, if a place is offered on the basis of false information being provided, then the place can be withdrawn.

Parent/Carer’s Signature…………………..………………………………………… Date ………………………

Parent/Carer’s Name ……………………………………………………………………..

Please take your child’s birth certificate (If not already seen) and this application form to the school office.

It is not mandatory for you to complete the following sections and the decision regarding allocating a place is not dependent on the information you provide. The reasons why we are asking for the information are provided below:

What is your first language?......
Are you fluent in English? YES / NO
(We ask this question so that we can try to have a translator available, if necessary)
Does your child have Special Educational Needs or Disabilities? YES / NO
(We ask this question so that we can be prepared to take further information to support your child, when you first meet with Nursery teachers)
Please provide your National Insurance Number or National Asylum Support Service (NASS) Number
Parent’s Name…………………………..……………………….. Date of Birth………./……../…………..
NI or NASS Number ……………………………………
Parent’s Name …………………………………………………… Date of Birth………/……../……………
NI or NASS Number ……………………………………
Joint family income £16,190 or less YES / NO
(We ask you to provide this information so that we can check whether you are eligible for £1320 of Pupil Premium Funding)
Funding code ……………………………………………………

Further details regarding funding for Nursery places can be accessed at:

Please refer to our comprehensive Pupil Privacy Notice on our website or hard copy held by the school office which records how we use information about you and what we do with it

FOR OFFICE USE ONLY
Birth Certificate copied for file Yes / No
Proof of Address copied for file Yes / No
In Catchment Yes / No
Date Received / / 20