Expression of Interest

Child's Surname

Child's First Name

Child's Middle Names (if none enter 0)

Date of Birth

Gender

Address

Parent 1

Title (Mr/Mrs etc)

Surname

First Name

Relationship to Child

Home Telephone

Mobile

Work Telephone

Parent 2

Title (Mr/Mrs etc)

Surname

First Name

Relationship to Child

Home Telephone

Mobile

Work Telephone

Preferred Start Date - Year

Preferred Term in which to start
Autumn (Sep - Dec)Spring (Jan - Mar)Summer (Apr - Jul)
Specific Start Date

I/we will be applying for funded early education & childcare for 2 year olds YESNO
NOTE: A link to the Norfolk.gov website where you can apply for funding can be found below this form

Please tick below the days and sessions that you would ideally like your child to attend - please note that at Little Gillies we recommend initially children attend a minimum of two sessions per week (6 hours).
Please Note: Morning session 09:00am - 12:00noon : Afternoon session 12noon - 3:00pm
Please select all sessions required
Monday amMonday pmTuesday amTuesday pmWednesday amWednesday pmThursday amThursday pmFriday amFriday pm

Is there any other information that you feel may assist, including details of any support the child may be receiving (for example for educational, behavioural or emotional issues)?
Additional Information (optional)
Enter your additional information here

Your Name

Your Email

I certify that:
I am the person with parental responsibility for the child named above and we reside at the address provided The information I have given is true to the best of my knowledge I will notify Little Gillies of any changes to the details above. I have read and agree to the Terms and Conditions