FORM: PAF APPENDIX C (Parent/Carer to complete)

Parent Authorisation Form - Appendix C- Extended Free Entitlement

This form must be completed in addition to the basic Parent Authorisation Form to start accessing a funded place. It can also be used to get written parental consent for a provider to validate an eligibly code.

Child’s Name / Child’s DOB

From September 2017 there is an Extended Free Entitlement for working families which will be up to an additional 15 hours per week for 38 weeks of the year if you meet the eligibility criteria.

To check if you are eligible for the Extended Free Entitlementgo to You will receive an eligibility code if you qualify. Please enter your details below as your childcare provider will need to validate this code before they can offer you a place.

Parent’s Surname
Parent’s National Insurance Number
30 Hours Eligibility Code from HMRC: (11 Digits)
  1. WEEKLY PATTERN OF ATTENDANCE - EXTENDED FREE ENTITLEMENT

Please discuss how you would like to access these additional hours with your childcare provider.Record below how you will be claiming your Extended Free Entitlement hours only. You can claim up to a maximum of 15 hours a week during term time. If you have agreed a stretched offer with your childcare provider, please also complete Appendix A.

Provider Name / Please enter the number of funded hours attended per day / Hours claimed per week
Mon / Tue / Wed / Thur / Fri / Sat / Sun
(A)
(B)
(C)
Total funded hours claimed per week (maximum of 15 hours) A+B+C
  1. PARENT / CARER AUTHORISATION

You must agree to the following declarations before you can start accessing your extended funded place. Please mark the box to show you agree.

I give consent for the childcare provider stated above to validate my eligibility code for the extended free entitlement. I understand that the childcare provider will share the information above with Suffolk County Council to verify my code, either by secure email or by the Provider Portal linked to the Local Authority system. / Yes, I agree
I understand that my childcare Provider will need to validate my code before they can offer me an extended free entitlement place. / Yes, I agree
I confirm allthe childcare provider/s / schools and funded hours my child attends are shown above for the extended free entitlement. / Yes, I agree
I confirm this provider can claim for the number of hours shown in row A) above for the extended free entitlement. / Yes, I agree
I confirm this provider can discuss my child’s pattern of attendance with the other chosen provider/s stated above so they can confirm where I would like to claim my extended free entitlement if applicable hours. / Yes, I agree