Dagenham Nursery Application Form

Application to to be included on the waiting list for a place at the nursery.

Child's Details

Name *

First

Last

Date Of Birth *

Parent / Carer's Details

Name *

First

Last

Address *

Postcode *

Telephone (home) *

Mobile *

Email *

Are you *With partnerSingle parentDon't wish to say

Childcare Requirements

Please tick below to let us know what times you will need childcare

Full Time (i.e 8.00am - 6.00pm):

• Mon
• Tues
• Wed
• Thurs
• Fri

Part-time - mornings (i.e 8.00am - 1.00pm):

• Mon
• Tues
• Wed
• Thurs
• Fri

Part-time - afternoons (i.e 1.00pm - 6.00pm):

• Mon
• Tues
• Wed
• Thurs
• Fri

Extra hour from 7-8am available at certain nurseries at extra cost

Submit

Privacy: The information you have given on this form will be confidential. We will hold this information on our systems for the purpose of compiling a waiting list for places at the nursery. The information will be processed in accordance with the local authority’s best practice and the requirements of the Data Protection Act 1998 and the new GDPR on May 2018. The information may be used by the local authority to promote the general welfare of children. We use information for statistical purposes to help us develop future services for parents and providers. Information held for statistical purposes will be depersonalised.