The woodland nursery on the edge of the city

Application Enquiry Form

Hardmoor Early Years Centre

This application places your child on our waiting list. We will contact you as soon as a suitable place becomes available. Please note that completion of this form does not guarantee a place for your child.

Date of Enquiry

Child's Name

Child's Date of Birth

Parent/Carer Name(s)

Address

Email Address

Mobile Phone Number

Additional Contact Number

Preferred method of Contact

Does your child have any Special Educational Needs or Disabilities requirements? (if yes please give details in the additional information section of this form) Does your child have any Special Educational Needs or Disabilities requirements? (if yes please give details in the additional information section of this form) Yes No

Does your child have any medical requirements? (eg. asthma, allergies) (if yes please give details in the additional information section of this form) Does your child have any medical requirements? (eg. asthma, allergies) (if yes please give details in the additional information section of this form) Yes No

Are there any other agencies involved with your child? (eg. portage, paediatrician, social worker,speech and language therapist)

Do you have any other children currently attending Hardmoor Early Years Centre? Do you have any other children currently attending Hardmoor Early Years Centre? Yes No

Have you had children previously attend Hardmoor Early Years Centre? If yes who was their key person?

What kind of Childcare are you looking for? What kind of Childcare are you looking for? All Year Round

If all year round, please specify days and times needed (sessions available are 8am to 4pm or 8am to 6pm)

OR - 3 year old funded hours, term time only (Please choose one) OR - 3 year old funded hours, term time only (Please choose one) 15 hours (9am to 12noon) 15 hours (1pm to 4pm) 30 hours (9am to 3pm, eligible 3 & 4 year olds)

OR - 2 year funded hours, term time only (eligible 2 year olds) (Please choose one) OR - 2 year funded hours, term time only (eligible 2 year olds) (Please choose one) 15 hours (8:45am to 11:45am) 15 hours (12:45pm to 3:45pm)

How did you hear about us?

Additional Information - Is there any other information you feel is relevant to your enquiry?

Number

8 + 3 =