Application – Brentwood Day Nursery

Applications

If you would like to make an application for your child, simply complete the form below and ensure you provide as much information as possible (please note some fields are mandatory *)

You can also request an application form by post from

Brentwood Day Nursery
Old County Ground
Shenfield Road
Brentwood
Essex
CM15 8AJ

Tel: 01277 212580
Email: manager@brentwooddaynursery.co.uk

Child Information

Child’s Name*

Child’s Surname*

Child’s Date of Birth*

Child’s Gender
FemaleMale

Child’s Ethnicity*

Parent 1 Information

Parent Full Name*

Relationship to Child*

Parent’s Address*

Postcode*

Phone Number* (mobile)

Email Address*

Parent 2 Information – (Skip if not applicable)

Parent Full Name

Relationship to Child

Parent’s Address

Postcode

Phone Number* (mobile)

Email Address*

Session Preference & Funding Options

Sessions Required

SCHOOL SESSION (8:30am-3:00pm)

Please answer Yes or No as appropriate

Monday

Tuesday

Wednesday

Thursday

Friday

FULL DAY SESSION (8:30am-5:30pm)

Please answer Yes or No as appropriate

Monday

Tuesday

Wednesday

Thursday

Friday

When would you like to start?

Please tick your funding eligibility

Free Early Years Entitlement (disadvantaged entitlement) for 2-3 years (term after 2nd birthday) FEEE2
15 hours a week (this offer is stretched over 51 weeks a year) and so therefore this equates to 11 hours a week *subject to availability
Yes

Free Early Years Extended Entitlement (parent working entitlement) for 2,3 & 4 years FEEE2W/3W
30 hours a week (this offer is stretched over 51 weeks a year) and so therefore this equates to 22 hours a week *subject to availability
Yes

Free Early Years Universal Entitlement for 3-4 years (term after 3rd birthday)FEEEUE15
15 hours a week (this offer is stretched over 51 weeks a year) and so therefore this equates to 11 hours a week
Yes

Special Provision Funding for children with Special Educational Needs and disabilities (SENIF)
Yes

Disability access funding (DAF)
Yes

Non funded
You do not receive any funding and so therefore the space will be fully chargeable. Our fee list can be provided
Yes

Registration Details

Please check the details you have provided and use the back button to edit any incorrect details. Once you are happy with your application, please sign below using your mouse to draw your signature, or if you’re using a smart device, use a finger or stylus to draw your signature in the designated space as appropriate

Parent/Carer Signature (Either Parent)