Nursery Place Request Form

Section 1: Your Information

Name

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Email Address

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Address

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Postcode

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Contact Number

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Date of Birth

Day01020304050607080910111213141516171819202122232425262728293031 Month010203040506070809101112 Year19601961196219631964196519661967196819691970197119721973197419751976197719781979198019811982198319841985198619871988198919901991199219931994199519961997199819992000200120022003200420052006200720082009201020112012201320142015201620172018201920202021 Invalid Input

Age at start of course:

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Section 2: Childcare Details

Course applied for (if known)

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Course start date (if known)

JanuaryFebruaryMarchApril MayJuneJulyAugustSeptemberOctoberNovemberDecember Invalid Input

Course end date (if known)

JanuaryFebruaryMarchApril MayJuneJulyAugustSeptemberOctoberNovemberDecember Invalid Input

Please indicate the days that you need childcare:

Monday

Tuesday

Wednesday

Thursday

Friday

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Section 3: Child's Details

Name of child:

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Date of Birth

Day01020304050607080910111213141516171819202122232425262728293031 Month010203040506070809101112 Year2014201520162017201820192020 Invalid Input

Age:

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Gender

MaleFemale Invalid Input

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How we use your personal information

The personal information you provide here, will not be shared with any third party company. It will solely be used for your request.

Further information about how we handle your personal information can be found on our College website at www.sthelens.ac.uk/privacy-policy

Are you a robot?

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