Application Form

Child’s full name:

Date of birth: *Male / Female

Parents/carers name:

Home address:

Postcode:

Telephone numbers: Main: Alternative:

Email address:

Children can start at Acorn Under Fives at the beginning of the term after their second birthday. You may request a start date in the Autumn, Spring or Summer Term. There may be limited places in the Spring and Summer Term and your child may be placed on the waiting list until more places become available.

Start date: *Autumn (September) / Spring (January) / Summer (April) Year:

Sessions / days requested: *Mon AM / PM Tue AM / PM Wed AM / PM Thu AM / PM Fri AM / PM

Any other information:

Where did you hear about us *: Internet Sibling attended Word of mouth Advertisement Other

* Please delete whichever is not applicable.

If we find that we no longer need the place, we will inform Acorn Under Fives as soon as possible.

Signature: Date:

NB: We are required to advise you that our records are held on a computer. We follow the principles of the Data Protection Act (1998) and the data will only be used by staff and members of the committee.

Charity Commission Reg. No. 295296

Oaklands Infant School · Butler Road · Crowthorne · Berkshire · RG45 6QZTel: 01344 752752 · Email: acornunderfives@weycp.org.uk · www.acornunderfives.com

Charity Commission Reg. No. 295296

Oaklands Infant School · Butler Road · Crowthorne · Berkshire · RG45 6QZTel: 01344 752752 · Email: acornunderfives@weycp.org.uk · www.acornunderfives.com