Home  Application and Admission form Children age 3-5

Application Form and Admissions Information (Children age 3-5)

Please note: you will be required to upload your child’s birth certificate and proof of address along with this application form

Current establishment (if any)
Does your child currently attend an early years establishment or childminder?
 
Blended placement

A blended placement allows you to split your 1140 hour entitlement with more than one provider.

Are you requesting a blended placement?
 
Early years establishment/provider choice

Please see information on our models of delivery and where they are available.

Please list your 5 chosen providers below in order of preference (please complete all 5 different options).

Establishment provider name

         

Please note: If you do not receive any of your choices, you will be allocated the nearest available place in your locality.

If you require us to allocate based on another criteria e.g. place of work, please indicate below.

Patterns of attendance

Please look at the options available in each of the models of the establishments you have chosen.

Please indicate your preference in the column for each of the models you have selected i.e. 1 for your most preferred, 9 for your least preferred.

Please use all options available to you as this will allow the establishment to best match your requirements to their available patterns.

Model 1 establishments

In a Model 1 establishment you can choose from the patterns below (Please indicate your choice from 1-9 with 1 being your first choice and 9 being your last choice).

Term time patterns    

   

   

   
Which full day you would prefer?
 

   
Which full day you would prefer?
 

Full year patterns

   

   

   

   

Model 2 establishments

In a Model 2 establishment you can choose from the patterns below (Please indicate your choice from 1-3 with 1 being your first choice and 3 being your last choice).

Term time patterns

 

 

 

Alongside your AM or PM you can also use 12.5 hours a week with a funded provider, if you are using these additional hours you should speak to the provider directly who will be able to inform you of their availability of spaces (these hours are calculated over the year based on the date your child starts).

Model 3 establishments

In a Model 3 establishment there is one pattern, full day 9.00am – 3.00pm (Please click yes if this is your choice).

Term time patterns

Whilst across all models we try to accommodate choices of patterns and days, this is dependent on availability in each establishment and you may be offered an alternative.

Childs personal details        
     

Birth certificate number details, this can be found on the upper right hand corner of your birth certificate

       

Other children in the family e.g. siblings accessing early learning and childcare

Establishment admissions information

Parent/Carer contact details

Parent 1

Relationship to child*
 
   
Is home Address same as child?*
 
 

Telephone number

Can be contacted in emergency? *
 
Can collect the child? *
 
Use contact details above as emergency contact 1 information? *
 
Parent 2
Relationship to child
Is home Address same as child?

Telephone number

Can be contacted in emergency?
Can collect the child?
Emergency contact 2
Relationship to child

Telephone number

Health information
             
Is any other agency involved with your child e.g. social work, health professional, speech and language etc?
Does this child have any long-term medical condition or disability?
If yes, has there been a professional assessment identifying a disability?
Does your child currently receive a service allocated by either your health visitor/ social worker e.g. day care support service?
 
Are your child’s immunisations up to date?
Has your child received a tetanus injection in the last 5 years?
Is your child allergic to any medication?
   

In order to ensure children are appropriately prioritised (Under North Ayrshire Council’s priority banding procedures) we may contact any agencies involved with your child for further information.

Arrangement for collecting your child from nursery      

If, for any reason someone else who is not on the list is collecting your child prior notice would require to be given.

Finalise form

Form completed by

   

Please attach proof of your child’s birth certificate and proof of address.

These should be uploaded as a:

  • pdf
  • jpeg
  • png

Please use portait format and make sure all the text can be clearly read. Documents of more than 1 page should be scanned as 1 file.

Please ensure that your file size is less than 4mb







Declaration

It is important that the information you give on this application form is as full and accurate as possible. This will help us when considering the allocation of places.

All of the information you give will be treated as strictly confidential. Information you give may be stored on computer.

If your circumstances change, or there are any changes to the information you give at the time of applying, it is very important that you inform North Ayrshire Council in order that they have up to date details when allocating places.

If you have any questions about the admissions process for children aged 3-5 you should contact: Early Learning & Childcare Team, Education Service – Communities Directorate, Cunninghame House, Irvine KA12 8EE: earlylearningchildcare@north-ayrshire.gov.uk, or (01294) 324942

I confirm that to the best of my knowledge, all of the information provided by me on this application form is accurate.

I agree that funding is applied for and guarantee this child is not receiving funding elsewhere.

I am also aware that North Ayrshire Council will carry out checks to ensure that public funds/resources are correctly allocated/awarded.

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Please ensure you have selected 5 different establishments.