Langford Village Community School - Nursery Parental Declaration Form

Parents Forms

Nursery Parental Declaration Form

Please complete the following Sections 1-6 below.
When complete, please come into the School Office between 9.30am-4.30pm with:

- Your identification
- National Insurance Number
- Your child’s Birth Certificate / Red Book / Passport

and once these have been seen, we will ask you to:
- Sign, Section 7, the Parental Declaration Form

Section 1 - Child's Details

Child's Legal Family Name:

Child's Legal Forename(s):

Name by which the child is known (if different from above):

Date of Birth:

Gender

Address:

Postcode:

Child's First Language:

Child's Ethnicity - Please tick from the options below:

Section 2 - Parents/Carer/Guardian's contact details

Full Name(s)

Telephone Number

Email Address

Section 3 - Your child's eligibility

Please provide (parent/carer) NI number/s that you completed your application for us to run a check on your behalf

Working Families Eligibility Code

NI Number(s)/NASS

Section 4 - Early Years Pupil Premium (EYPP) registration form

The Early Years Pupil Premium (EYPP) is an additional sum of money paid to childcare providers for some children, this additional sum will be used to support your child if eligible.

If you believe that your child may qualify for the EYPP please provide the following information of the main benefit holder so eligibility can be checked.

Do you believe that your child may qualify for the additional EYPP funding?

Parent's Date of Birth

Parent's National Insurance Number

Disability Access Fund Declaration

Children who are in receipt of child Disability Living Allowance and are receiving the free entitlement are eligible for the Disability Access Fund (DAF). Please take a copy of your current DLA award letter to your childcare provider for them to claim the funding.

Does your child currently receive DLA?

If your child is splitting their free entitlement across two or more settings, please nominate the main setting where the local authority should pay the DAF

Setting details

Section 6 - Attendance Details

You need to agree and complete this declaration form with each setting your child attends for their funded entitlement to ensure that funding is paid fairly to each of them.

Your child can attend a maximum of two sites in a single day and if your child attends more than one setting we will distribute the funding appropriately between the settings.

Please note each settings claim will be completed based on 38 weeks of the year. For example, 15 hours per week over 38 weeks of the year = 570 hours – this is the maximum claim. If your child attends this over 50 weeks of the year your total funded hours per week will be 11.4. Any changes to hours within the year should be added to the grid with the effective start date of the new hours.

My child is attending the following settings:

Setting Name 1

Funding start date

Total fuded hours per week

Number of weeks per year

Total number of hours a week based on 38 weeks of the year

Additional hours (privately paid for) per week

Setting Name 2

Funding start date

Total fuded hours per week

Number of weeks per year

Total number of hours a week based on 38 weeks of the year

Additional hours (privately paid for) per week

Section 7 - Parents/Carer/Guardian Declaration

Please go into the School Office to sign the declaration.

Don't forget to take Photo ID, your NI number and your child's ID (Birth Certificate / Red Book / Passport)