Application Form

All information contained in this form will be treated in the strictest confidence

WIZKIDZINC

DETAILS OF CHILD

First name

DATE OF BIRTH

Last name

DETAILS OF PARENT(S)

PARENT/CARER ONE

First name

Last name

PARENT/CARER TWO

First name

Last name

MAIN CONTACT INFORMATION

Address

PARENT/CARER TWO

STREET ADDRESS

ADDRESS LINE 2

CITY

POSTCODE

HOME TEL NO

COUNTY

WORK TEL NO

MOBLIE NUMBERS*

APPLICATION DETAILS

DO YOU HAVE LEGAL RESPONSIBILITY FOR THE CHILD?

YES

RELATIONSHIP TO CHILD

IS THERE ANYTHING ELSE THAT YOU FEEL WE SHOULD KNOW ABOUT YOUR APPLICATION FOR YOUR CHILD?

EXPECTED ATTENDANCE REQUIRED FOR CHILD
Please select your preferred sessions below. Please note that exact sessions will be confirmed with you by the Nursery Manager dependent on availability. Some nurseries offer an early start and late finish at 7:30am and 6:30pm. Please check this availability and additional cost with the Nursery Manager..

TAX FREE CHILDCARE

Please enter your Eligibility Code if paying ALL or PART of your nursery fees using the government’s Tax-Free Childcare scheme.

IMPORTANT

ANTICIPTED START DATE REQUIRED

CONFIRMATION

I confirm the above details are accurate, and that I have read and accept the Terms & Conditions by which care is provided for my child. I confirm that I have parental responsibility for the child named above.

YOUR NAME

Thanks for registering !

Application Form

All information contained in this form will be treated in the strictest confidence

WIZKIDZINC

DETAILS OF CHILD

DETAILS OF PARENT(S)

MAIN CONTACT INFORMATION

APPLICATION DETAILS

TAX FREE CHILDCARE

IMPORTANT

CONFIRMATION

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