Nightingale Day Nursery
APPLICATION FOR NURSERY PLACE
Child
First names	________________________________
Last name	________________________________
Date of birth	________________________________
2. Parent / Carer
Name	________________________________
House and Street	________________________________
locality	________________________________
county	________________________________
Post Code	________________________________
Tel No.	________________________________
Details
Days / Sessions required	________________________________
	________________________________
	________________________________
Start Date	________________________________
Other Comments	________________________________
	________________________________
Deposit
	A deposit of one month's fees will be required to secure your child's place at the nursery (please contact us to confirm the exact deposit amount, as this will depend on the number of sessions required)
	The deposit is NON-REFUNDABLE if you later decide not to take the place. It is only refunded when your child leaves, providing there are no fees outstanding. Please note a deposit is NOT required until your child's place is comfirmed.
Signatures
Date	________________________________
Parent Signature	________________________________
For Staff use - Staff Signature	________________________________