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Everton Nursery School and Family Centre

Child Application Form

Child's Name*

Child's Date of birth*

Day

Month

Year

Gender*

Type of Place required *

Two Year Old Funded Place

Two Year Old Paid Place

Three to Five Year Old 30 Hours

Three to Five Year Old 15 Hours

Child's Home address with Postcode*

Email*

Contact Phone number (The number will be used to contact parents/carers regarding status of application, please call: 0151 233 1969 if there are any changes)*

AM. (Preferred sessions required (although your choice cannot be guaranteed) *

Mon

Tues

Wed

Thurs

Frid

PM. (Preferred sessions required (although your choice cannot be guaranteed) *

Mon

Tues

Wed

Thurs

Frid

Child's information

Nationality*

Religion:*

Ethnicity:*

Languages spoken at home:*

Asylum Seeker *

Yes

No

Refugee*

Yes

No

Special Educational Needs*

Medical Needs*

Parent 1 full legal name*

Parent 1 Date of birth*

Parent 1 Address*

Parents 1 NI or NAS Number*

Parent 2 full legal name*

Parent 2 Date of birth*

Parent 2 Address*

Parent 2 NI or NAS Number*

Child's Doctor*

Child’s Health Visitor*

Child’s Social Worker*

Current/Previous Nursery or Childminder Attended:

Signed Parent/Carer:*

Date*

Day

Month

Year

Please see our Privacy Notice

I have seen the Privacy Notice:*

Yes

No

How Did You Hear About Us?*

Friend or Family

Instagram

Website

Children's Centre

Location

Everton Nursery School and Family Centre
Spencer Street
Liverpool
L6 2WF

Telephone: 0151 233 1969

Mail

Contact us

Translation Disclaimer

Email: evertonnsfc@evertoncentre.liverpool.sch.uk

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