Please enable JavaScript in your browser to complete this form.GDPR Agreement *I consent to having this website store my submitted information so they can respond to my inquiry.Child's Name *FirstMiddleLastDate of Birth - must be BEFORE 1st September 2021 *Gender *MaleFemaleNHS Number *Your relationship to the child: *(e.g. mother/father/carer/stepmother/stepfather/social worker)Your child’s permanent address (at time of application) *Special Educational Needs - Does your child have a Statement of Special Educational Needs or Educational Health and Care Plan (EHCP)? *YesNoAt risk - Is your child, or a sibling of your child, subject of an inter-agency child protection plan and has been placed on the Child Protection Register? (Please provide evidence with this form) *YesNoChildren in Public Care - Is your child looked after, or was previously looked after and is now adopted, or with a child arrangements or special guardianship order? *YesNoSocial or medical reasons - Do you have a particular medical or social need to go to this school? (Please upload the supporting evidence below) *YesNoSocial or Medical Evidence Click or drag a file to this area to upload. If you have a sibling at this school, enter their name and date of birth:Full NameDate of BirthDate of BirthEarly years setting child attends or has attended (if applicable) *YesNoN/AIf the answer to the above question is Yes please provide the name of the Early years setting:Roundwood are offering 30 hours free child care. If applying for 30 hours free childcare, please provide your HMRC code:Monday *AMPMAM + Lunch (extra charge)AM + Lunch + PM (extra charge)Tuesday *AMPMAM + Lunch (extra charge)AM + Lunch + PM (extra charge)Wednesday *AMPMAM + Lunch (extra charge)AM + Lunch + PM (extra charge)Thursday *AMPMAM + Lunch (extra charge)AM + Lunch + PM (extra charge)Friday *AMPMAM + Lunch (extra charge)AM + Lunch + PM (extra charge)If you have any other requirements please enter here:Your Name *Address *Address Line 1Address Line 2CityState / Province / RegionPostal CodeEmailIf you are unable to receive information electronically, please leave this blank and we will post your notification letter to you. Daytime Telephone Number *Mobile Number *Electronic Signature *DECLARATION The information I have given on this form is complete and accurate. I understand that my personal information will be held securely and will be used only for local authority purposes. I agree to Roundwood Primary School using this information to consider my application for a nursery place. I understand that if any part of this completed application form is found false the offer of a place will be withdrawn. I understand that the completion of an application form does not guarantee a place in the nursery class. I understand that, if offered a place in the nursery class, I will have to apply separately for a place in reception.Date *File Upload Click or drag a file to this area to upload. CommentSubmit
