Early Education Entitlement (EEE)

Parental Declaration Form 2016/17 for Early Years Provider Use Only

Parent Information

  • This Parental Declaration will set out the hours and patterns of access to the EEE that the parent and provider have agreed to and will be valid for ______
  • The notice period to leave the setting for EEE is ______week/month
  • Failure to adhere to this may result in the repayment of your EEE or your EEE funding being withdrawn at a new Provider by the London Borough of Havering.
  • Maximum entitlement remains at 15 hours per week if claiming EEE at 2 Providers (max 570 hour/year if over more than 38 weeks).

Child’sdetails (Please PRINT)

First Name / Surname
Date of Birth (please provide birth certificate) / Gender (please delete as appropriate) / Male/Female
Home Address / Post Code
Home Telephone
Mobile Number

Child attends the following setting(s) (please PRINT)

1 ) Setting Name / Date Registered / Date Started / Days / Hours Attending per week / Hours Claiming per term
2 ) Setting Name / Date Registered / Date Started / Days / Hours Attending per week / Hours Claiming per term

If any provision is attended outside of Havering please state name of the Local Authority:

London Borough of: ______

Parental Declaration Form 2016 / 17 for Provider Use Only

Parental Declaration

By signing this declaration, I agree with the following conditions of thefree entitlement to my child at age two, three or four:

  • I understand that the 15 hours free entitlement must be free at the point of delivery and that I cannot be charged for this in advance by the Provider.
  • I have received a EEE Parent Guide 2016/17 from the Provider and have been advised of additional services available for my child and I understand that I will have to pay fees for these services
  • I understand that I have to provide notice in line with the Provider’s terms and conditions in order for the EEE funding to follow my child if they move to another Provider during the funded term
  • If I do not adhere to the notice period as stated on this agreement I agree that I may be liable for the cost of the EEE at this or any other EEE Provider.
  • I understand that if my child leaves the Provider / increases or decreases their hours the Provider will complete a Funding Transfer Calculation request and submit this to the LA.
  • My child is not registered to claim more than the maximum free entitlement hours for the term as follows: Summer 2016 = 195 hours, Autumn 2016 = 210 hours and Spring 2016 = 165 hours.
  • I will provide details of any new Provider to ensure a smooth transition, should I decide to change my child’s EEE Provider
  • If I do not inform any additional settings that an agreement is in place and has been breached then I am liable for the cost of EEE at any other Provider

Name of Parent / Carer (please PRINT)
Signature of Parent / Carer / Date

EEE Provider Use Only

Date of next Parental Contract Review
Signed by (please Print) / Date

EEE – A Detailed Guide for Providers April 2016 – March 2017

For Provider use only, this is not a Local Authority document.

Appendix 12