University Of Birmingham Nursery Place Application Form
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4Day Nurseries
Application for a nursery place
Child information
Please complete a separate form for each child
Child details
First name
Surname
Date of birth/baby due date
Home address
Postcode
Telephone number
Ethnic origin
Language(s) spoken at home
If English is not the main language spoken at home,
YES
NO
Please tick the appropriate box:
will this be your child’s first experience of an English
speaking environment?
If Yes please discuss with your child’s key person
Are there any festivals or special occasions
celebrated within your family that your child will
be taking part in and that you would like to see
acknowledged and celebrated while he/she
is at our setting?
Required nursery usage
Please tick the appropriate boxes:
Full-time (Monday – Friday)
Part-time (Minimum usage per child – 2.5 days)
If part-time (please tick sessions required)
Monday:
Tuesday:
Wednesday:
Thursday:
Friday:
Place required from
am
pm
am
pm
am
pm
am
pm
am
pm
Date
University of Birmingham students only:
Commencement date, if different from the term dates below:
I am a student at the University and require a University
term place only (Please tick box if required)
Date
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Parent category: Business