YOU SHOULD NOT COMPLETE THE REMAINDER OF THIS FORM YOUR CHILD HAS ATTENDED THEIR FIRST FUNDED SESSION WITH THE PROVIDER Provider and attendance details Parents/legal guardians need to agree and complete a Declaration Form for each provider where their child attends for funded early education, in order to ensure that funding is paid correctly and hours are not exceeded. Universal Hours Funded Childcare I am claiming the following number of universal funded early education hours for my child: Provider name(s) Number of universal funded early education Total Term time Please list all providers your child hours attended per day number of (T) or is claiming funded universal hours and funded stretched Mon Tue Wed Thu Fri Sat Sun give details of the number of hours you hours per (S) are claiming per day/week. week 1) 2) 3) 4) Total number of universal funded hours per day at this provider Date my child will start using funded universal hours Leaving date (if applicable) 30 Hours Funded Childcare I am claiming the following number of extended funded education hours for my child: Provider name(s) extended Total Term time Number of funded early education number of (T) or Please list all providers your child hours attended per day is claiming funded extended hours and funded stretched Mon Tue Wed Thu Fri Sat Sun give details of the number of hours you hours per (S) are claiming per day/week. week 1) 2) 3) 4) extended Total number of funded hours per day Date my child will start using funded extended hours at this provider Leaving date (if applicable) NOTE The maximum number of funded hours across universal and extended is 10 per day. – ---------------------------------------------------------------------------------------------------------------------------------------
YOU SHOULD NOT COMPLETE THE REMAINDER OF THIS FORM YOUR CHILD HAS ATTENDED THEIR FIRST FUNDED SESSION WITH THE PROVIDER Provider and attendance details Parents/legal guardians need to agree and complete a Declaration Form for each provider where their child attends for funded early education, in order to ensure that funding is paid correctly and hours are not exceeded. Universal Hours Funded Childcare I am claiming the following number of universal funded early education hours for my child: Provider name(s) Please list all providers your child is claiming funded universal hours and give details of the number of hours you are claiming per day/week. Number of universal funded early education hours attended per day Total number of funded hours per week Term time (T) or stretched (S) Mon Tue Wed Thu Fri Sat Sun 1) 2) 3) 4) Total number of universal funded hours per day Date my child will start using funded universal hours at this provider Leaving date (if applicable) 30 Hours Funded Childcare I am claiming the following number of extended funded education hours for my child: Provider name(s) Please list all providers your child is claiming funded extended hours and give details of the number of hours you are claiming per day/week. Number of extended funded early education hours attended per day Total number of funded hours per week Term time (T) or stretched (S) Mon Tue Wed Thu Fri Sat Sun 1) 2) 3) 4) Total number of extended funded hours per day Date my child will start using funded extended hours at this provider Leaving date (if applicable) NOTE – The maximum number of funded hours across universal and extended is 10 per day. ---------------------------------------------------------------------------------------------------------------------------------------
Declaration-Form-Autumn-2018.docx