34 St Michael’s Park Bristol BS2 8BW (rear of the University Social Sciences Library) Tel: 0117 927 6077 Email: Registered with Ofsted APPLICATION FOR A NURSERY PLACE 1. Child’s Forename(s): Child’s Surname: Name child goes by: 2. Date of Birth OR Due Date 3. Gender M F (dd/mm/yyyy): (please circle): 4. Child’s main Home Address (including postcode): 5. Family email address(es): 1. 2. Details of child’s carer 1: 6. Name of carer 1: 7. Telephone: (home) (work) (mobile) 8. Are you (Carer 1) a If Y, name of course and student number? current University of Y N Bristol student 9. Are you a current member (If carer 1 is UoB staff) Will you be eligible to join the of staff, please provide nursery salary sacrifice scheme for payment of nursery payroll number ( ) Y N fees? and name of Faculty Y N N/A _____________________ 10. Expected course If you are a Undergraduate completion date or end of student, contract (if fixed term (please circle): Postgraduate staff) dd/mm/yyyy 11. Will you be a UoB staff Student Further information (e.g. your start date): member or student when Y N Staff your child will start at the Y N nursery? Details of child’s carer 2:
34 St Michael’s Park Bristol BS2 8BW (rear of the University Social Sciences Library) Tel: 0117 927 6077 Email: Registered with Ofsted APPLICATION FOR A NURSERY PLACE 1. Child’s Forename(s): Child’s Surname: Name child goes by: 2. Date of Birth OR Due Date (dd/mm/yyyy): 3. Gender (please circle): M F 4. Child’s main Home Address (including postcode): 5. Family email address(es): 1. 2. Details of child’s carer 1: 6. Name of carer 1: 7. Telephone: (home) (work) (mobile) 8. Are you (Carer 1) a current University of Bristol student Y N If Y, name of course and student number? 9. Are you a current member of staff, please provide payroll number ( ) and name of Faculty _____________________ Y N (If carer 1 is UoB staff) Will you be eligible to join the nursery salary sacrifice scheme for payment of nursery fees? Y N N/A 10. Expected course completion date or end of contract (if fixed term staff) dd/mm/yyyy If you are a student, (please circle): Undergraduate Postgraduate 11. Will you be a UoB staff member or student when your child will start at the nursery? Student Y N Staff Y N Further information (e.g. your start date): Details of child’s carer 2:
Application%20form%20(NEW%20Final)_DD.docx