Application to join Humpty Dumpties Nursery at Darwen Access Point

Name of child		Date of birth
Name(s) and address of parent(s)/guardians
Postcode		Telephone
I/We would like		to start attending nursery
*from		(date)
Days/sessions required
Mon                Tues                Wed                Thurs                Fri
A.M                 A.M                  A.M                 A.M                 A.M
P.M                 P.M                  P.M                 P.M                 P.M
Please circle the days/sessions required
Fees for: 0 – 2 year olds,  A.M: £15,   P.M: £15, All day: £28                          2 – 3 year olds,  A.M: £14,   P.M: £14,  All day: £26                                       3 – 5 year olds,  A.M: £13,   P.M: £13,  All day: £24 For 3-5 year olds, the education grant will be deducted from the fees once they are eligible (15 hours weekly. Funding available term time only) and for full time children, a £5 weekly concession will be given. (Fees may increase fractionally each year) Please note that the nursery is open all year round except for bank holidays and 1 week at Christmas. These are not chargeable
If we find that we no longer need the place, we will inform the setting as soon as possible.
Signature of parent
------------------------------------------------------------------------------------------------------------------------------   Application to:                                                      Humpty Dumpties
A place will be available for			(child’s name)
* on			(date)
*We will notify you when a place becomes free.
Signed for the setting
Name		Title