Nursery application form - Learning Community Trust

Which LCT academy nursery are you applying for(Required)

What date would you like your child to start (if accepted)(Required)

Selection of your preferred sessions, this will be discussed further with you when we contact you after processing your application
Please note: all session are subject to availability, and additional sessions may not be available at all academy - please see the academy website for further details

Please indicate the days and sessions you would prefer.

Would you be interested in any additional session (if available at your select academy)(Required)

Breakfast club sessions

Lunchtime care session

Afterschool care session

About your child

Forname(s)(Required)

Surname(Required)

Date of birth(Required)

Gender assigned at birth(Required)

Male

Female

Does this child have any siblings already attending the select academy(Required)

Yes

Please list all sibling names which will be at the selected academy on your requested start date(Required)

Forename(s)

Surname

Date of birth

Does this child currently attend another childcare setting(Required)

Yes

Please provide the name of the current setting(Required)

Is this child currently in the care of the local authority(Required)

Yes

Please provide the name of the local authority(Required)

Does this child have any additional educational or medical needs that is necessary for the wellbeing of the child?(Required)

Yes

Please provide additional information(Required)

Medical evidence, please provide medical evidence to support your application. If you are unsure please check with your health visitor or doctor.(Required)

Drop files here or

Accepted file types: jpg, png, pdf, doc, docx, jpeg, Max. file size: 5 MB.

Your/parental contact details

Forename(s)(Required)

Surname(Required)

Relationship to child(Required)

Do you have parental responsibility for the child(Required)

Yes

Address - this address should be your address and the address of the child(Required)

Address line 1 Address line 2 Town/city County Postcode Country

Primary contact number(Required)

Alternative contact number

Email address(Required)

Enter your email Confirm your email

Funding for your child's nursery place

Talking 2's funding
Talking 2's funding must be applied for online through Telford & Wrekin Council's website.

Do you have Talking 2's funding(Required)

Yes

Please provide your Talking 2's code(Required)

Working funding entitlement
Working funding entitlement must be applied for online through childcarechoices.gov.uk.
Funding entitlement is 15 hours for 2 year olds and 30 hours for 3-4 year olds.

Do you have working funding entitlement?

Yes

Please provide your working funding entitlement/30 hours code(Required)

Applicant parent forname(s)(Required)

Applicant parent surname(Required)

Applicant parent national insurance number(Required)

Applicant parent date of birth(Required)

Declaration

Details that you give on this application form may affect the outcome of your application. Details of your child's home address are particularly important. Any place offered may be withdrawn if your application is found to be fraudulent or intentionally misleading.

I understand to notify the academy if I change my address
I certify that the information I have given is correct to the best of my knowledge, I understand by signing this form I am giving the academy and the Learning Community Trust permission to use my personal details to facilitate this application in line with their data protection policy.
Any information I have supplied may be used to access further relevant funding for my child at nursery.
I have parental consent for this child

Signature(Required)

Signed date

Apply for a nursery place

Apply today for an LCT nursery

About your child

Your/parental contact details

Funding for your child's nursery place

Declaration