Parent Funding Declaration Form – Farm View Day Nursery

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Wokingham Borough

Farm View Day Nursery

This form may be used as authority for the provider to check the funded early education portal for Early Education Funding (EEF) 9 month plus, 2,3&4 Year Olds & Early Years Pupil Premium (EYPP) 3&4 Year Olds

To complete this form you will need to be the parent or carer that applied for the funding code with HMRC.

You must show your child’s full birth certificate or passport to the nursery manager, deputy or your child’s room leader before completing this form.

You will also need the following:

Your national insurance number

Your funding award code / letter from the borough (if Applicable)

DLA award letter (if applicable)

Child’s Details

Child's legal first name *

Name by which the child is known (if different from legal name):

Child's legal family name *

Child's middle name (opt)

Date of Birth *

Gender *

Male
Female

Address Line 1 *

Have you shown child's ID to the Nursery? *

Address Line 2

Child's First Language *

Town or City *

Ethnicity- Please choose *

RBWM /AFC is required by the government to collect this information

Postcode *

Parents Details

Which funding will you be claiming? *

9 Month Funding
2 Years Funding
3 Years 15 hours Funding
3 Years 30 hours Funding

Eligibility Code *

This is an 11 digit number. If you do not have an eligibility code but have received a letter from the local authority, please contact your nursery team. You MUST have this number before completing this form.

Parent legal first name *

Date of Birth *

Parent legal family name *

National Insurance Number *

Setting and attendance details for Universal and Extended Entitlements

Parent/Carers must complete this Declaration Form with each setting their child attends for their early education entitlement. Your child can attend a maximum of two sites in a single day, and if your child attends more than one setting you must specify where the funding is paid. If your child qualifies for the 3 & 4 Year Old extended hours entitlement and your child attends more than one setting you must indicate at which setting(s) you are claiming the universal and extended entitlements.

When is your funding starting? *

Spring term, January – April
Summer term, May – August
Autumn term, September – December

How many hours are you claiming with Wise Owls Childcare? *

15 Universal Hours in full
30 Universal and Extended Hours in full
Other

What days does your child attend Wise Owls? *

Monday
Tuesday
Wednesday
Thursday
Friday

What days does your child attend Wise Owls? *

Monday
Tuesday
Wednesday
Thursday
Friday

How many hours per week will you be claiming with Wise Owls? *

What days does your child attend Wise Owls ? *

Monday
Tuesday
Wednesday
Thursday
Friday

What is the name of the other setting your child will attend? *

How many hours per week will this other setting claim? *

Which 2 Year old plus funding are you claiming? *

Working Parent, (with a code from HMRC)
Supported (with a letter of eligibility from the borough)

Please upload a photo of your eligibility letter from the Borough

Click or drag a file to this area to upload.

How many hours are you claiming with Wise Owls Childcare? *

15 Hours in full
Other

What days does your child attend Wise Owls? *

Monday
Tuesday
Wednesday
Thursday
Friday

How many hours per week will you be claiming with Wise Owls? *

What days does your child attend Wise Owls? *

Monday
Tuesday
Wednesday
Thursday
Friday

What is the name of the other setting your child will attend? *

How many hours per week will this other setting claim? *

How many hours are you claiming with Wise Owls Childcare? *

15 Hours in full
Other

What days does your child attend Wise Owls? *

Monday
Tuesday
Wednesday
Thursday
Friday

How many hours per week will you be claiming with Wise Owls? *

What days does your child attend Wise Owls? *

Monday
Tuesday
Wednesday
Thursday
Friday

What is the name of the other setting your child will attend? *

How many hours per week will this other setting claim? *

Early Years Pupil Premium (EYPP)

The Early Years Pupil Premium (EYPP) is an additional sum of money paid to childcare providers for children of families in receipt of certain benefits. Do you believe that your child may qualify for the EYPP ? *

Parent / Carers Name

First

Last

Parent / Carers Date of Birth

Parent/ Carers NI Number or NASS Number

Adopted Children, Children Subject To A Special Guardianship Order Or A Child Arrangements Order 3 or 4 year old children receiving the Universal early education funding (EEF) will also be eligible for EYPP if any of the following additional criteria apply: They have been in local authority care for 1 day or more in England or Wales They have been adopted from care in England or Wales They have left care under a special guardianship order or child arrangement order (formerly a residence order) in England or Wales

Please type ‘YES’ if these criteria apply

Please note that although checks may confirm eligibility for EYPP or 3 & 4 Year Old Extended hours for a 2 or 3 year old, the child will only be able to access these entitlements when they have reached the statutory early education funding entitlement age – from the start of the term after the term in which the child turns 3

Disability Access Fund Declaration

Is your child eligible and in receipt of Disability Living Allowance (DLA)? *

Three- and four-year old children who are in receipt of child Disability Living Allowance and are accessing the 3 & 4 Year Old Universal Early Education Entitlement (maximum 15 hours per week) are eligible for the Disability Access Fund (DAF). DAF is paid to the child’s early years setting as a fixed annual rate

Please upload a copy of your most recent DLA award letter *

Click or drag a file to this area to upload.

If your child is splitting their 3 & 4 Year Old Universal entitlement (15 hours) across two or more providers, please nominate the main provider where the local authority should pay the DAF:

Parent/Carer/Guardian with legal responsibility declaration

9 Month plus funding price per month *

2 days per week at £512.75
3 days per week at £932.13
4 days per week at £1327.75
5 days per week at £1590.94
Option if not using full funding with Wise Owls

2 Years plus funding price per month *

2 days per week at £491.88
3 days per week at £888.94
4 days per week at £1262.25
5 days per week at £1503.13
Option if not using full funding with Wise Owls

3 Years plus funding price per month *

2 days per week at £458.23
3 days per week at £852.08
4 days per week at £1098.83
5 days per week at £1321.72

3 Years plus funding price per month *

3 days per week at £441.20
4 days per week at £751.13
5 days per week at £1011.54

Please confirm that you will not be using full funding hours at Wise Owls and that you have spoken with head office and agreed the amount of funded hours you will be using and the adjusted fees. *

I understand that I will pay a monthly fee that covers the hours outside the funded period, consumables and food. I am aware of these fees. and that they will be subject to review as part of our terms and conditions *

I confirm that the information I have provided above is accurate and true. I understand and agree to the conditions set out in this document and I authorise Wise Owls Childcare to claim Early Education Funding as agreed on behalf of my child. In addition, I also agree that the information I have provided can be shared with the Local Authority and Department for Education, who will access information from other government departments to confirm my child’s eligibility and enable this provider to claim Early Years Pupil Premium (EYPP) or Disability Access Fund (DAF) on behalf of my child.

Print full name *

Signature *

Clear Signature

The personal details supplied on this form will be held by Wise Owls Childcare and the Borough of Wokingham and processed in accordance with the Data Protection Act (DPA) and privacy notices.

Date *