THE POND APPLICATION FORM
Please make sure you read the admission criteria attached to this form
CHILDS SURNAME:FIRST NAMES / BOY/GIRL
DATE OF BIRTH / DAY: / MONTH: / YEAR:
CHILD POSITION IN FAMILY
(i.e. 2ND, 3RD ETC)
ADDRESS
POSTCODE / ……………………………………………………………………………
……………………………………………………………………………
……………………………………………………………………………
TELEPHONE DETAILS
(These details are for the first priority carer) / HOME: …………………………………………………………….....
MOBILE: …………………………………………………………….
WORK: ……………………………………………………………...
EMAIL: ………………………………………………………………
ETHNIC/CULTURAL DETAILS / COUNTRY OF BIRTH: ………………………………………..……..
FIRST LANGUAGE: ………………………………………………….
ETHNIC ORIGIN: …………………………………………….……….
RELIGION: …………………………………………………….…….…
PREVIOUS NURSERY/PLAYGROUP
If a choice were available, which session would you prefer? (Please tick) (Your choice cannot be guaranteed)
Morning (8.30-11.30) / Afternoon (12.30-3.30)
Do you have any other children at a Frays Academy school? / YES/NO / SCHOOL:
NAME/S:
Are you eligible for ‘Free Early Education Eligibility’? (Funding for 2 and 3 year olds)
YES/NO / You may be eligible for funding if …
Your household’s annual income in under £16, 190.
And you receive any of these benefits:
· Income support
· Income-based Job Seekers Allowance
· Income-related Employment and Support Allowance
· Support under Part 6 of the Immigration and Asylum Act 1999
· The Guaranteed element of State Pension Credit
· Child Tax Credit and/or Working Tax Credit and have an annual income under £16,190.assessed by Her Majesty's Revenue and Customs
· The Working Tax Credit 4-week run on (the payment you get when you stop qualifying for Working Tax Credit)
· Universal Credit
· Child is looked after by the local authority
· Disability Living Allowance
Have you applied for funding via
the Hillingdon website? YES/NO
Parent’s National Insurance Number:
Parent’s Date of Birth:
/ /
We will use this information to check if your child is eligible for Two Year Old funding, which will prioritise their place on the waiting list. We use the funding to pay for staff, resources and our general running costs.
Children attending ‘The Pond’ will be given priority when applying for the next age group at a Nursery within the Trust. Please note, this does not guarantee a reception place.
Would you be interested in applying
for a nursery (for 3 and 4 year olds) place
at one of our schools? / Yes: / No:
School:
Are there any additional matters you
would like the Governors to take
into consideration when allocating places?
MOTHER’S FULL NAME
FATHER’S FULL NAME
Signed:
Date:
Office Use Only / Date Received / b/c checked
Making Leaps for Young Children