Coldfall Primary School /
Coldfall Primary school, Coldfall Avenue, Muswell Hill London N10 1HS. Head Teacher - Mrs E B Davies /

Admissions and Extended Day

Application Form

Nursery

2018-2019

Coldfall Primary School

Section 1 / Child’s Details / Please tick the appropriate box
First Name / D.O.B.
Family Name
Gender / Male / Female
Section 2 / Parent/Carers/Family Details
Parent or Guardian / Contact 1 / Contact 2
First Name
Family Name
Address
Please provide 2 documents
dated in the last 2 months as proof of address.
Home Telephone Number
Mobile Number
Email:Please print clearly
Third Contact
Please provide the name and mobile number of a person to contactin case of an emergency if we cannot contact you. / Name
Relationship to the child / Mobile No.
Siblings / Date of Birth / Class
Section 3 - Previous Nurseries Attended
Name / Date started / Leave date
Section 4 - Lunchtime Arrangements/Allergies
Will your child require school meals? (Full time only).
We require payment for school meals each half term in advance. / Yes / No
Does your child have any food allergies or / Yes / No
dietary restrictions? If yes please list allergies/restrictions in the adjoining box.
Section 5 - Country of Birth
In which country was your child born?
What is your child’s nationality?
Section 6 – Ethnicity Please tick the box
White -British / Indian
White - Irish / Pakistani
White – Traveller of Irish Origin / Bangladeshi
White- Roma / Other Asian Background
Greek / Caribbean
Greek Cypriot / Other Black Background
Turkish Cypriot / Somali
Albanian (Excluding Kosovan) / Nigerian
Kosovan / Congolese
White European / Other African Background
Other White Background / Latin American
White and Black African / Kurdish
White and Asian / Other Ethnic Background
Other Mixed Background / Chinese
Section 7 – Religion Please tick one
Christian / Muslim
Jewish / Sikh
Hindu / No Religion
Buddhist / Other Religion
Section 8 - Language
Do you speak a language other than English at home? If so which language?
Section 9 - Photographic Permission
Do you give the school permission to take and use photographs of your child? The photographs could be used for the school website, school publicity or used by the local press etc.
Yes No
Section 10 - Permission For Trips
Do you give permission for your child to
a)Take part in school trips and other activities that take place away from the school premises?
b)Be given first aid or urgent medical treatment during any school trip or activity?
Yes No
Section 11 - Medical
Does your child have contact with any medical agencies (education welfare officer, education psychologist, speech and language therapist etc.)? If so could you please provide a name, professional title and a contact number.
Name and Title______
Phone no. ______Borough______
Medical need______
Section 12 – Special Educational Needs
Do you consider your child
to have a disability or special
educational need?
If yes could you outline the
special need in the adjoining box and attach relevant
documentation. /
Yes No
______
______
______
Section 13 - Our Nursery Provision

We are able to offer nursery provision between 8am and 6pm each day. Everyone is entitled to 15 hours free of charge however you need to checkif you are entitled to 30 free hours before you apply by visiting:

Please indicate the session you are applying for by ticking one of the boxes below.
Morning 9am –
12 noon / Afternoon 12.30pm – 3.30pm / Full Day 9am – 3pm

Please note free entitlement can only be taken in the core hours listed above.

If you are eligible for 15 hours and require extra paid sessions please select by ticking the boxes below.(Subject to availability).

Please select the session you require from the chart below by ticking in the boxes
Monday / Tuesday / Wednesday / Thursday / Friday
Morning 9am–12 noon
Afternoon 12.30pm – 3.30pm

If you require either morning or afternoon extended day hours please select from the sessions below.

Please select the session you require from the chart below by ticking in the boxes
Monday / Tuesday / Wednesday / Thursday / Friday
8am - 9am £8 per day
*3.00pm –3.30pm £4 per day
3.30pm – 6pm £20 per day
3pm -6pm £24 per day

*The half hour session3.00 pm-3.30pm will only be available to full-time children whose siblings are attending Coldfall Primary school.

Deposit Agreement
We will ask you to pay a deposit for the additional nursery hours or for extended day. If your child is to attend both extra nursery hours and extended day hours then only one deposit of £140 will be required.
I agree to pay a deposit of £140 which will be held for the year and will be deducted from the second summer term payment if there are no current outstanding balances on your account.
Exact details of how to pay will follow however we ask you to make all paymentseach half-term in advance.
Name of child: ______
Signature of Parent/ Carer: ______

Please note once you have made your selection you cannot change your options until the following term.

Section 14 - Over Subscription Criteria

If we receive more applications than spaces available we will apply the following admissions criteria.

Priority will be given to:

*Children in Care or looked after or previously looked after children

*Children with an exceptional social or medical need

*Children with asibling already attending Coldfall Primary School

*Children of staff who have been at Coldfall for 2 years or more.(This is in order for the school to recruit

and retain outstanding teachers).

* Distance of address from school

Important dates
You will be informed of the outcome of your application by the end of April 2018 and you will need to confirm that you will be accepting the place by 7th May 2018.
Section 15–Family Income
We use this information to determine eligibility for the Pupil Premium grant which will be used to enhance your child’s education.

Is your joint family income over £16,190 per year? YES NO
If you tick yes there is no need to read the rest of this section.
If you are in receipt of any of the following benefits could you please ask a member of the office team for a Free school meals/pupil premium registration form
  • Income Support
  • Income-based Jobseekers Allowance
  • Income-related Employment and Support Allowance
  • Support from the National Asylum Support Service under part 6 of the immigration and Asylum Act 1999
  • Child Tax Credit (without Working Tax Credit) with an annual income of no more than £16,190
  • Working Tax Credit run-on
  • Universal Credit
Print name of Parent/Carer: ______
Signature of Parent/Carer: ______
Date: ______

Please complete all sections of this form and return it to the school office by 31st March 2018together with a copy of your child’s birth certificate, two current utility bills and any supporting documentation relating to your child’s special educational needs (if applicable). If you are applying for 30 free hours we will also need an authorisation document from HMRC.

The information you have submitted to us will be used in accordance with theData Protection Act 1998

  • The information recorded on this form will be stored electronically and in paper format. This information will be used to enable Coldfall Primary School staff to offer appropriate support.
  • This information may be shared with partner organisations, funding bodies and other professional agencies for monitoring and evaluation purposes.
  • This information may be shared with other professional agencies if there are safety concerns about me or my child.
  • All this information will be kept in line with the Data Protection act 1998 and I will have the right to access any information held about me or my child.
  • Your personal information will not be passed to organisations for marketing or sales purposes.

Admissions check list – For office use only
Date received
Name of child
Initials of person receiving this form
Birth Certificate received
Proof of address x 2
Place applied for / 15 hours / 30 hours
Additional Hours / Mornings / Evenings
Evidence of eligibility received
SEND
Sibling
Distance
Additional Information

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