Rosendale Children’s Centre

Childcare application form

Please useCAPITALS and complete one application form for each child requiring a childcare place
Your family and contact details
Name of child: / D.O.B:
Name(s) of parents/carers:
Home address:
Postcode:
Home telephone no: / Mobile no:
Email address:
Your childcare requirements
What type of place would you like to apply for? Please see our Fee Policy for more information
Non funded - fee paying only
Please select the number of days a week that you require
2 days / 3 days / 5 days
Please select which days of the week you require
Monday / Tuesday / Wednesday / Thursday / Friday
My requirements are flexible / Comments:
2, 3 or 4 year old Free Early Learning Entitlement only
Please select 1 option below
3 sessions a week - 9:00-1:00 / 3 sessions a week - 1:00-5:00
3 or 4 year old ExtendedFree Early Learning Entitlement only
Please select 2 full days and 1 AM session
Monday AM / Tuesday AM / Wednesday AM / Thursday AM / Friday AM
Monday PM / Tuesday PM / Wednesday PM / Thursday PM / Friday PM
My requirements are flexible / Comments:
2, 3 or 4 year old Free Early Learning Entitlementwith payable top up hours
Please select all sessions that you require
Monday AM / Tuesday AM / Wednesday AM / Thursday AM / Friday AM
Monday PM / Tuesday PM / Wednesday PM / Thursday PM / Friday PM
My requirements are flexible / Comments:

Please turn over to complete your application

Additional Information
What date do you require a childcare place from?
Does your child currently attend another childcare provision? / Yes / No
What is your notice period for your current childcare provider?
What is your Eligibility Reference Number?
(Eligibility Reference Number required for 2 year Old Free Early Learning Entitlement only)
Do you or your child have any additional needs that you would like us to be aware of?
Declaration
I confirm that the information on this form is accurate at the time of writing and I understand that it is my responsibility to update the children’s centre should any information change.
Parent/carer signature: / Date:
What happens next
Please return your completed application form by email to or by post to Rosendale Primary School & Children’s Centre, Rosendale Road, London SE21 8LR.
The children’s centre will send you an email to confirm receipt of your application and the date it has been placed on the waiting list. If you do not receive this email within a week of submitting your application, we may have not received your application, so please contact us.
Application reviews are completed regularly and by email. It is your responsibility to keep your email address up to date. Failure to do this may result in your removal from the waiting list.
The children’s centre will contact you when a childcare place becomes available that suits your requirements. At this stage you will be invited to view the children’s centre childcare.
Office use only
Date received: / Staff signature: / Confirmation email sent:
Notes: