Child's Name: *

First

Last

Child's Date of Birth: *

Gender: *

• Male
• Female

Child's Address: *

Address Line 1

City

State / Province / Region

Postal Code

3 year old Preferred Session

Preferred Session: *

• Morning
• Afternoon
• Flexible
• Full Days

Are you entitled to a 2 year funded place? *

• YES
• NO

Are you entitled to a government 2 year place? *

• YES
• NO

Which days would you like to request? *

(AM, PM, full days, 2.5 days (M-W) or (W-F)

Medical information

Does your child have any allergies we need to be aware of? *

• YES
• NO

If yes, please specify below:

Child's Doctor & Practice Address *

Address Line 1

City

State / Province / Region

Postal Code

Is your child registered with a dentist? *

• YES
• NO

Dentist Surgery:

Address Line 1

City

State / Province / Region

Postal Code

Does your child have any health issues we need to be aware of? *

• YES
• NO

Does your child have any special educational/developmental needs? *

• YES
• NO

Does your child have any involvement with Health, Social Care or any other support agencies?

Any other information you would like us to know?

I give permission for nursery to contact my child’s Health Visitor in order to support their learning in school? *

• YES
• NO

Has your child ever been subject to a Child Protection Plan?

Any other information you would like us to know?

Has your child previously attended any other childcare provision? *

• YES
• NO

Additional Information about previous provision

Proposed Primary School

Siblings

How many siblings does your child have? *

Siblings please note if you have another child/children who will require a nursery place at a future date, please complete the table below.

Please add potential start date. (DD/MM/YYYY)

Child's Name:

First

Last

Child's Date of Birth:

Parent/Guardian's Name: *

First

Last

Parent/Guardian Email Address: *

Phone *

Anything else we should know?

Name of parent or guardian completing the form: *

First

Last

Submit

Admission Arrangements

Where demand for places at these nursery schools and classes exceeds the number of places available, the following admission arrangements are used to decide which children will be admitted to nursery. This is to ensure as far as possible that all nurseries are servicing the needs of their local communities, and providing support for children and families most in need.

Oversubscription Criteria for 2 Year Olds

1. ‘Looked after children’ meaning children accommodated by the Local Authority.
2. Parental home residence within the defined catchment area of the school.
3. Concurrent sibling link – brother or sister only attending the nursery when the child will be admitted (this includes adoptive siblings, half siblings, step siblings, long-term fostered children residing at the same address).
4. Shortest distance from the centre of the parental home residence (including flats) to the main nursery entrance as measured as a straight line using the Local Authority Geographical Information System with those living closer to the nursery receiving higher priority.

The distance measurement will be used as a tie-breaker within each criterion, where necessary.

Oversubscription Criteria for 3-4 Year Olds

1. ‘Looked after children’ meaning children accommodated by the Local Authority.
2. Children with special educational needs.
3. Children who require professional support for example, children who have English as a second language.
4. Concurrent sibling link – brother or sister only attending the nursery when the child will be admitted (this includes adoptive siblings, half siblings, step siblings, long-term fostered children residing at the same address).
5. Shortest distance from the centre of the parental home residence (including flats) to the main nursery entrance as measured as a straight line using the Local Authority Geographical Information System with those living closer to the nursery receiving higher priority.

The distance measurement will be used as a tie-breaker within each criterion, where necessary.

There is no right of appeal against an offer of a free early years place. However, you may contact the Early Years Team if you believe your child has not received his or her free entitlement.
Early Years Team
Level 0, Broughton Street
South Tyneside Council & Civic Offices
Westoe Road
South Shields
NE33 2RL
Telephone: 0191 4246119