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Fee paying application forms

Please complete each section of the electronic application form below and click on the 'submit' button.

 In line with our Data Protection processes your application form will be shredded if your child does not access a place at the nursery.

When you use our nursery, we’ll ask for and record yours and your child’s personal information. We may share your information with other organisations, such as school when they are transitioning into the care and education system, only information that is required and appropriate to support your child will be provided. To find out more about how we use your information please see our Nursery Privacy Notice.

If you have any questions please contact the nurseries.

Jack In The Box 01753 635480

Kiddies' Cabin 01753 638733

Little Dragons 0118 9585316

Please complete all fields marked with an asterisk *.

Application to use nursery facilities - fee paying attendance

Date of application: *
Name of nursery place is required in: *	Jack in the Box Kiddies' Cabin Little Dragons
Date that a place is required: *
Name of applicant/s:*
E-Mail of applicant: *
Relationship to child:*
Child's Details
Who has parental responsibility for the child: *
Child’s full name: *
Date of birth: *
Gender: *	Male Female
First language: *
Who does the child live with: *
Does your child have any additional needs such as a speech delay or hearing impairment, if so please provide full details:
Does your child have or are you currently awaiting a statement of special educational needs, if so please provide full details:
Has your child ever been referred to any of the following:
Speech Therapist Yes No	Paediatrician Yes No	Dietician Yes No
Occupational Therapist Yes No	Physiotherapist Yes No	Social Services Yes No
Audiologist Yes No	Psychologist Yes No	Domestic Violence Team Yes No
If yes please provide full details:
Does your child have any allergies, if so please provide full details:
Is your child breast fed? * Yes No
Details of Parent/Guardian 1
1. First name: *
Last name: *
Relationship to child:*
Home address: *
Postcode: *
Home tel no:
Mobile tel no: *
E-Mail: *
Trust employed by (if applicable):
Job title:
Place of work:
Work tel no:
First language: *
Details of Parent/Guardian 2
2. First name:
Last name:
Relationship to child:
Home address:
Postcode:
Home tel no:
Mobile tel no:
E-Mail:
Trust employed by (if applicable):
Job title:
Place of work:
Work tel no:
First language:
Sessions/Days Required * Our three nurseries offer full day attendance only and there is a minimum attendance of 2 days per week.
Full Day Monday Tuesday Wednesday Thursday Friday 7.30 am - 5.30 pm 7.45 am - 5.45 pm 8.00 am - 6.00 pm

    

Please note that the information you provide on this form regarding your child will not affect the offer of a place in the nursery. It will simply help us to provide the most suitable care for your child.

Jack in the Box Nursery in Slough Upton Hospital, Albert Street, Slough, Berkshire, SL1 2BJ 01753 635480

Kiddies' Cabin Nursery in Maidenhead St Marks Hospital, 112 St Marks Road, Maidenhead, Berkshire, SL6 6DU 01753 638733

Little Dragons Nursery in Reading 57-59 Bath Road, Reading, Berkshire, RG30 2BA 0118 9585316