Free Early Education for Two Year Olds Application Form

Please complete the details below to find out if your child is eligible.

Please only use full legal names when completing this form, including middle names for child if applicable.

Information for parents and carers about free childcare for 2 year olds

Name of person completing form: *

If not the child’s parent/ carer, please tell us what your role/ relationship to family is e.g. Health Visitor:

Applicant's Details

Relationship to child: *

Title: *

First name(s) *

Surname: *

Address: *

Postcode: *

Contact Telephone Number: *

E-mail: *

Date of birth: *

National Insurance number: *

Husband/ Wife/ partner's details

Relationship to child:

Title:

First Name:

Surname:

Date of Birth:

National Insurance number:

Child's details

First name (s): *

Middle name (s):

Surname: *

Date of birth: *

Gender *

Male

Female

Correct information *

I certify that the information given on this form is correct to the best of my knowledge and belief.

I understand that the Council may check with the Department for Work and Pensions (DWP)/ Her Majesty’s Revenue and Customs/ National Asylum Support Service for the purpose of confirming my eligibility. The Council will share your information with other teams within Children’s Services in order to provide a comprehensive service to you and your family. The Council will not share information with any other third party without your consent or as required by law.

We would also like to share your details with your local Children’s Centre for them to provide you with information on services available to you.

Not share information

Please tick this box if you do not want your information shared in this way.

Data protection statement

The information you have provided may be shared across Bath and North East Somerset Council for the purpose of dealing with your enquiry. We will not give information about you to anyone else, or use information about you for other purposes, unless your consent has been given or the law allows this.

The use of your personal information is covered by our registration under the Data Protection Act 1998. You can, under this legislation, request a copy of the information we hold about you. If any information we hold about you is incorrect please let us know.

Bath and North East Somerset Council is committed to upholding the principles of the Data Protection Act, and will not process your information in a way incompatible with these principles.

The Council’s Information Compliance Office can be contacted on (01225) 477000 or via email at information_governance@bathnes.gov.uk

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