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Everton Nursery School and Family Centre
Child Application Form

Child's name

Child's date of birth

Gender

Type of Place required

Two Year Old Funded Place

Two Year old Paid Place

3 - 5 Years Old 30 Hours

3 - 5 Years Old 15 Hours

Home address

Contact Phone number (The number will be used to contact parents/carers regarding status of application, please call: 0151 233 1969 if there are any changes)

AM. (Preferred sessions required (although your choice cannot be guaranteed)

Mon

Tue

Wed

Thu

Fri

PM. (Preferred sessions required (although your choice cannot be guaranteed)

Mon

Tue

Wed

Thu

Fri

Child's information Nationality:

Religion:

Asylum Seeker

Yes

Special Educational Needs

Ethnicity:

Languages spoken at home:

Refugee

Yes

Medical Needs

Parent 1 full legal name

Parent 1 Date of birth

Parent 1 Address

Parents 1 NI or NAS Number

Parent 2 full legal name

Parent 2 Date of birth

Parent 2 Address

Parent 2 NI or NAS Number

Child's Doctor

Child’s Health Visitor:

Current/Previous Nursery or Childminder Attended:

Signed Parent/Carer:

Date

Child’s Social Worker:

I have seen the data protection sheet:

Yes

Staff use

Date

Name

Thank you for your application. We'll get back to you as soon as possible.

Location

Everton Nursery School and Family Centre
Spencer Street
Liverpool
L6 2WF

Telephone: 0151 233 1969

Mail

Email: evertonnsfc@evertoncentre.liverpool.sch.uk

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Everton Nursery School and Family Centre Child Application Form

Everton Nursery School and Family Centre
Child Application Form