Application Form

Please use our application form below to apply for a child placement at Little Stars Day Nursery.

If you would like to download our paper version to fill in please click here to download and print our paper application and return to our address at Little Stars Day Nursery, Nuns Corner, Grimsby, North East Lincolnshire, DN34 5BQ.

Bring your child’s I.D(s) that has your child’s date of birth on it along with you to Little Stars Day Nursery.

Please fill in all the required fields marked with an asterisk.*

1Your Childs Name

2Parents Details

3Dr & Immunisations

4Dietary Info

5Session Req

6Permissions

7Submit

Child's Details

Child's Name(Required)

First Last

Child's Date Of Birth(Required)

Child's Address(Required)

Street Address City / Town Postal Code

Childs Gender(Required)

Boy

Girl

Other

Child's First Language(Required)

Child's Ethnic Origin(Required)

Child's Religion(Required)

Child's Next Of Kin(Required)

Who has parental responsibility?(Required)

If other responsibility(Required)

Parents Details

Select from single or both parents details

Parent One Details

Your Email Address(Required)

Name(Required)

Prefix First Last

Place of Work(Required)

Your Phone Number(Required)

Your Work Place Phone Number(Required)

Date of Birth(Required)

GIFHE Student(Required)

Yes

Is GIFHE Student

Course tutors name

Telephone

Parent Two Details

Your Email Address (Parent Two)

Name (Parent Two)

Prefix First Last

Place of Work (Parent Two)

Your Phone Number (Parent Two)

Your Work Phone Number (Parent Two)

Date of Birth (Parent Two)

GIFHE Student (Parent Two)(Required)

Yes

Is GIFHE Student (Parent Two)

Course tutors name

Telephone

Emergency Contact Information

Please add your Emergency Contact Information below

Emergency Contact Information(Required)

Name

Relationship

Contact No

Doctor & Immunisations

Doctors Name(Required)

Health Visitors Name

Address(Required)

Street Address Town/City Postal Code

Phone Number(Required)

Immunisation Information

Please add the dates of your child's Immunisations

Diphtheria(Required)

HIB(Required)

MMR(Required)

Whooping Cough(Required)

Polio(Required)

Tetanus(Required)

Dietary & Other Information

Any allergies or medical problems we should be aware of?(Required)

If yes please provide details of the allergies or medical problems

Any special dietary requirements?(Required)

If yes please provide details of the special dietary requirements

Are there any other agencies involved with your child?(Required)

If yes please provide details of the agencies

Does your child attend another setting?(Required)

If yes please provide name and details of the other setting

Special Educational Needs Code of Practice(Required)

I acknowledge the fact Little Stars Day Nursery adheres to the Special Educational Needs Code of Practice and that staff have a duty to keep records with regard to Safeguarding children issues. Outside agencies that may be contacted include Families Information Service, Inclusion Support Officer, Health Visitor and Families First Access Point.

I acknowledge

Session Requirement

Please select below the session number requirements you are wanting for your child.

Monday AM

Monday PM

Tuesday AM

Tuesday PM

Wednesday AM

Wednesday PM

Thursday AM

Thursday PM

Friday AM

Friday PM

Declaration & Submit Application

We aim for our setting to be realistic and flexible with our fees and payment policy whilst being competitive with our competitors, however it is necessary within our nursery to have set guidelines so we are all clear of our expectations. Please read our full payment policy here

Payment Policy(Required)

I agree to the Little Stars payment policy which I've read and understood on this page

I Agree

Privacy Statement(Required)

I agree to the Little stars privacy statement which I've read and understood on this page

I Agree

Terms & Conditions(Required)

I agree to the Terms & Conditions and understand that gifhelittlestars.co.uk has a legitimate interest to process the data that I have submitted. See our Terms and Conditions for more information.

I Agree

Signature(Required)

Name

This field is for validation purposes and should be left unchanged.