Walton Lane Nursery School and Rocking Horse Club

Application form for a childcare/nursery place at Walton Lane Nursery School and Rocking Horse Club

Child's Details

Child's legal forename(s)* Child's legal family name (surname)* Date of birth*

Select one of the following*MaleFemale

Child's address* Postcode* Child's home language*

Is the child in public care (looked after)*YesNoDon't know

Is the child known to Children's Integrated Services (Social Worker)*YesNoDon't Know

Does the child have an Education Health Care Plan (EHCP)*YesNoDon't know

Is the child known to the Educational Psychology Service*YesNoDon't know

Is the child known to Portage / Lancashire Specialist Teaching Service*YesNoDon't know

Does the child have a disability*YesNo

Does the child have an illness*YesNo

Please give any additional information of medical, social or welfare circumstances of the child or family. Please also provide the details of any persons/professionals who could support this application e.g. doctor/health visitor

Parent / Carer Details

Parent / Carer 1

Parent / carer's legal forename(s)* Parent / carer's legal family name (surname)* Parent / carer's address (if different from child's) Parent / carer's postcode Parent / carer's email* Parent / carer's telephone number*

Parent / Carer 2 (optional)

Parent / carer's legal forename(s) Parent / carer's legal family name (surname) Parent / carer's address (if different from child's) Parent / carer's postcode Parent / carer's email Parent / carer's telephone number

Requested hours of attendance

Children can access government funded education and paid childcare at Walton Lane Nursery School and Rocking Horse Club. Please see the session times on the website and indicate the hours you would like your child to attend*
	Session (hours required)
Monday
Tuesday
Wednesday
Thursday
Friday

- Government funded places are available for children aged from 9 months to 4 years according to the Lancashire Parental Agreement and Terms and Conditions.
- Childcare fees for paid places are paid one month in advance before the last working day of each month.
- Walton Lane Nursery School is a Lancashire County Council maintained nursery school and as such, abides by the Lancashire admission criteria.

I confirm that the information on this form is accurate*

Name
Date

Application Form

Child's Details

Parent / Carer Details

Parent / Carer 1

Parent / Carer 2 (optional)

Requested hours of attendance