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Ellingham C of E Primary School
Ellingham
Chathill
Northumberland
NE67 5ET
Tel/Fax: 01665 589233
Email:Admin@ellingham.northumberland.sch.uk
Website: www.ellingham.northumberland.sch.uk
This communication is available in alternative format on request
Mrs D Lakey : Headteacher
A small school with a big heart
Where each person can become what God has made them to be
Ellingham C of E Primary School Early Years Unit Application Form
Details of child
First Name Date of birth
Last Name Boy or Girl.
Current childcare provision attended if applicable
Does your child have any special needs or medical conditions Yes/No
If yes please give details ..
..
Details of Parent(s) or carer(s)
Mother/female carers name .
Address .
Postcode .Telephone Number..
e.mail address.Mobile Number..
Emergency contact number ....
Father/male carers name
Address
PostcodeTelephone Number..
PLEASE COMPLETE THE OTHER SIDE
Sessions requested
Please tick which sessions you would like your child to attend. This can be changed at the beginning of each term.
Monday 8.45 12.00 Monday 8.45 1.00 Monday 8.45 3.15
Tuesday 8.45 12.00 Tuesday 8.45 1.00 Tuesday 8.45 3.15
Weds 8.45 12.00 Weds 8.45 1.00 Weds 8.45 3.15
Thursday 8.45 12.00 Thursday 8.45 1.00 Thursday 8.45 3.15
Friday 8.45 12.00 Friday 8.45 1.00 Friday 8.45 3.15
Lunch hour The lunch hour can be taken as part of your 15 or 30 hours government free funding but an additional 2.50 will be charged for lunch. You can if you prefer send your child with a healthy packed lunch.
Does your child have any allergies. YES/NO
Please indicate if you think you will be applying for the 15/30 hour free child care. Conditions apply, if you are unclear please look at https://www.childcarechoices.gov.uk YES/NO
Will your child require milk? This is free to children under 5 YES/NO
Details of siblings
Name of brother or sister d.o.b...
d.o.b.
Declaration
I confirm that the information given by me on this form is correct. I understand that if I have given false information the place offered may be withdrawn. I have read the admissions policy and understand that acceptance to the Early Years Unit does not guarantee transfer into the school.
Is your child in public care (i.e. looked after by the council) .Yes/No
If yes please provide details of Social Worker ....
Please indicate your relationship to the child...
Full Name (please print)..
Signed . Date.
It is useful for us to see your childs 2 year progress check. Please indicate if you are happy to share this with us. YES / NO
If there are no places at the time of application would you like your child to be placed on a waiting list?
YES / NO
Please return to Ellingham C.E Primary School. A copy of your childs birth certificate is required with this application form
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