Days Required: Full Days/Am/Pm

Application Form

Week commencing:

Days required: full days/am/pm

Room child are starting in:

Child’s Details

Full name of child:

Name by which child is usually known: Male/Female

Date of Birth:

Home address:

Post code:

Telephone No.: Mobile No.:

Nationality: First language spoken:

Parents Information

Mothers/Partners Name: Contact No.:

Place of work: Mobile No.:

Fathers/Partners Name: Contact No.:

Place of work: Mobile No.:

Emergency Contacts

Please give names of family or friends who can be contacted if parents/carers are unavailable.

Name: Contact No.:

Name: Contact No.:

Who will be collecting your child

Please state who will normally collect your child and a password you would like them to use if they were to collect your child, also the names of any additional people who will collect your child?

Password:

(This can be change at any time)

Medical information

Name and Address of Doctor:

Details of immunisations:

Name of Health visitor:

Does your child have any allergies?

Medical problems:

Any special dietary requirements:

Additional Information:

Do you have any other relevant information regarding your child? E.g. sleep pattern.

Signed:

Relationship to child;

Nursery use:

Event: / Date completed:
Key group name
Key group staff members
Learning journey implemented
Self registration name available

In accordance with OFSTED regulations your consent is required for the following;

Emergency Medical treatment as required: YES/NO

To use plasters on your child YES/NO

Your child to go on nursery outings outside of the nursery premises i.e. park/library etc… with appropriate child/adult ratio YES/NO

To apply nappy and sun cream (Provided by parent) YES/NO

Taking of photos to capture your child’s development: YES/NO

Signed:

I have read and understood the policies and procedures of Y tots Nursery and I am happy to abide with all the policies and procedures.

Signed:

Key worker:

Date of application:

Nursery Manager signed:

Where did you hear about Y-tots? (Leaflets, from a friend etc…)

……………………………………………………………………………

Fylde Coast YMCA
Please fill in the whole form using a ball point pen and send to: / Instruction to your
Bank or Building Society
to pay by Direct Debit
Fylde Coast YMCA
St Albans Road
St Annes
Blackpool
Lancs
FY8 1XD / Originator's Identification Number
8 / 0 / 8 / 4 / 4 / 3
Name(s) of Account Holder(s) / Reference Number
Instruction to your Bank or Building Society
Bank/Building Society account number / Please pay Fylde Coast YMCA Direct Debits from the account detailed in this Instruction subject to the safeguards assured by the Direct Debit Guarantee.
I understand that this Instruction may remain with Fylde Coast YMCA and, if so, details will be passed electronically to my Bank / Building Society.
Branch Sort Code
Name and full postal address of your Bank or Building Society / Signature(s)
To: The Manager Bank / Building Society
Address
Postcode / Date

Banks and Building Societies may not accept Direct Debit Instructions for some types of account

"
This guarantee should be detached and retained by the Payer.
The
Direct Debit
Guarantee
· This Guarantee is offered by all Banks and Building Societies that take part in the Direct Debit Scheme. The efficiency and security of the Scheme is monitored and protected by your own Bank or Building Society.
· If the amounts to be paid or the payment dates change Fylde Coast YMCA will notify you 10 working days in advance of your account being debited or as otherwise agreed.
· If an error is made by Fylde Coast YMCA or your Bank or Building Society you are guaranteed a full and immediate refund from your branch of the amount paid.
· You can cancel a Direct Debit at any time by writing to your Bank or Building Society. Please also send a copy of your letter to us.
Name / Main Qualification / Responsible for
Kath Howard
Manager / Level 4 / All areas
Vicki Wignall
Nursery Supervisor,
Student Mentor & P.I.C.O Co-ordinator / NVQ3 / All areas
Lisa Fish
Nursery Receptionist / All Nursery work
Emma Cooper
Equalities Champion / NVQ3 / 0-2’s Role Play & Snuggle Area
Amanda Keen
Outdoor Play Co-ordinator, Behaviour Management Officer & E.L.A.C / Level 4 / 2-3’s Construction
Kirsty Twigg
0-2’s Tots Tops
Co-ordinator / NVQ3 / Messy Play & Small World
Katie McEvoy
Equalities/SEN Champion,
Language/Planning Co-ordinator / NVQ3 / 2-5’s Role Play Story Corner
Emma McCormack
Out of School Supervisor / NVQ3 / Top Tots Co-ordinator & Small World
Jenna McDermott
Sensory/Tactile
Co-ordinator / NVQ3 / Sensory
Louise Ager
Construction &Tiny Talk Co-ordinator / NVQ3 / Table Tops
Kate Fagan
0-2’s Construction
Co-ordinator / NVQ2 Trainee / Construction & Sand & Water
Holly Fairbrother
SEN & PICO Co-ordinator / NVQ3 / Messy and Malleable activities
Janet Waldermar / NVQ 3 / Role play and Drama
Sarah Jane Mclelland /
NVQ 2 / Book Area
Neighbourhood Nursery Initiative (NNI) Nursery Place - Parents Questionnaire

The setting that your child attends is a designated NNI nursery and the Local Education Authority (LEA) requires the following data for monitoring purposes only. It would be much appreciated if you could complete the form and hand it to the Nursery Manager/Officer in Charge.

Child's details
Name of child (optional):
Age of child:
(please tick the appropriate box)
Under 1 / 1 year+ / 2 years+ / 3 years+ / 4 years+ / 5 years
Number of weekly sessions attended:
(please tick the appropriate box)
1 session / 2 sessions / 3 sessions / 4 sessions / 5 or more sessions
Number of hours attended per week:
(please tick the appropriate box)
up to 20 hours a week / 20 hours or more a week
Child's ethnic origin:
(please tick the appropriate box)
White
British / Irish / Traveller / Other (specify)
Mixed:
White and Black Caribbean / White and Black African / White and Asian / Other (specify)
Asian or Asian British:
Indian / Pakistani / Bangladeshi / Kashmiri / Other (specify)
Black or Black British:
Caribbean / African / Other (specify)
Chinese
Chinese / Other specify)
Other Ethnic group:
Please specify:
Family characteristics - work/training
Home Postcode address: / WardName(if known):
Family structure:
(please tick the appropriate box)
Two parent family / Lone parent:
1st Parent:
Parent working full-time (35 hours+) / Parent working more than 16 hours
Parent working less than 16 hours / Parent currently in Higher/Further Education
Parent taking skills for life or step into Learning
Parent not working or training
2nd Parent:
Parent working full-time (35 hours+) / Parent working more than 16 hours
Parent working less than 16 hours / Parent currently in Higher/Further Education
Parent taking skills for life or step into Learning
Parent not working or training
Family characteristics - Financial Support
Parents accessing Child Tax Credit
Parents accessing Working Tax Credit
Parents accessing Learning Skills Council/Higher Education Childcare/Access Fund Support
Parents accessing Care 2 Learn support
Child whose place is sponsored by Sure Start Local Programme
Child whose place is sponsored through European funding
Child whose place is sponsored through government funded regeneration schemes eg SRB
Child whose parents receive financial support towards childcare from their employer
Child in receipt of 3 and 4 year old funding

Thank you for completing this form, please leave it with a member of staff with your application form

Nursery Sessions and Fees

Age of child / Morning session 8am to 1pm / Full day
8am-6pm / Afternoon session
1pm-6pm / Weekly
Cost
5 full days
0-2 / £15.55 / £31.10 / £15.55 / £155.50
2-3 / £15.05 / £30.10 / £15.05 / £150.50
3-5 / £14.50 / £29.00 / £14.50 / £145.00

At the moment we close for bank holidays but if we feel there is a demand for opening, it will be considered. You will not be charged for days the nursery is closed.

A payment of two weeks in advance will be required in order to reserve a place for your child.

Fees will be taken from your bank account on the 1st and 15th of every month through direct debit. Direct debit forms to be returned with application forms.

Fees are reduced by the appropriate amount if nursery or company vouchers are used for part payment.

The full fees must be paid for all booked sessions, including those when your child is absent through illness. Each child will be entitled to 10 days holiday at 50% giving we receive 2 weeks prior notice.

Late collection of your child can cause the nursery a major problem as we are legally bound to work to a strict child/staff ratio. Late collection of your child may result in another child not being admitted for their session, or staff members having to remain after their working hours to care for your child. There will be a charge if late collection of a child is continuous.

If you have any special circumstances or session requirements that you wish to be considered, these can be discussed in private with the nursery manager.

01253 872320

The Lofthouse Building

London Street

Fleetwood

FY7 6JL

Out of school clubs

FlakeFleet Primary school &

Lofthouse Building

01253 872320

OFSTED Registration number EY285518