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Application to join. Pop Up Nursery, Venture Centre, 103A Wornington Road, London, W10 5YB Nicola 07741248301, Nursery Number 07437057411, Venture Centre 020 8960 3234
Child's Details
First name(s) of child
*
Surname of child
*
Child's date of birth
*
Date Format: MM slash DD slash YYYY
Address
*
Address Line 1
Address Line 2
City
Postcode
Parent/Carer Details
Parent/carer name (1)
*
Relationship to child
*
Address (if different)
Address Line 1
Address Line 2
City
Postcode
Email
*
Daytime/work tel
*
Home tel
*
Mobile
*
Parent/carer name (2)
Relationship to child
Address (if different)
Address Line 1
Address Line 2
City
Postcode
Email (if different)
Daytime/work tel
Home tel (if different)
Mobile
Session request
Preferred start date
Date Format: MM slash DD slash YYYY
Please tick the sessions you would like your child to attend
Mornings (9:00-12:00)
Monday
Tuesday
Wednesday
Thursday
Friday
Afternoon (12:00-15:00)
Monday
Tuesday
Wednesday
Thursday
Friday
All Day (9:00-15:00)
Monday
Tuesday
Wednesday
Thursday
Friday
Terms and Conditions
This application places your child on our waiting list. We will contact you as soon as a suitable place becomes available. Please note that completion of this form does not guarantee a place for your child. Once your child is offered a place and you accept it, on admission further personal information and family details are required for our records. Your child’s birth certificate is required at this point with a copy made for our file. If you find that you no longer need the place, please inform us as soon as possible. Should you decide you no longer need the place we will not retain the details on this application form (see our Privacy Notice).
Signed parent/carer (1):
*
I agree to the terms and conditions.
Please be advised that this application form and offer of a place is subject to [our/my] terms and conditions provided to you. By ticking this box, you acknowledge that you have read, understood and agree to these terms and conditions.
Signed parent/carer (2):
I agree to the terms and conditions.
Please be advised that this application form and offer of a place is subject to [our/my] terms and conditions provided to you. By ticking this box, you acknowledge that you have read, understood and agree to these terms and conditions.
Date
Date Format: MM slash DD slash YYYY
Email
This field is for validation purposes and should be left unchanged.
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