Request for early entry into a primary school

First Name

Middle Name

Surname

Date of Birth

Current pre-school/nursery

Primary school that your child will attend

Name of Parent/Guardian

Address

Address 2

Town

Postal Code

Telephone number

E-mail address

Please indicate the position of other children within your family

Child one

Child two

Child three

Child four

Has your child had any involvement with any of the following professionals?

Questions	Yes	No
Speech and Language	Yes	No
Health	Yes	No
Educational Psychologist	Yes	No
Social Work	Yes	No

Questions	Yes	No
Have you read our parental leaflet "Early Entry to Primary School"?	Yes	No
Have you had the opportunity to discuss your child with pre-five staff and/or the Head Teacher of the school?	Yes	No
Have you received a copy of the profile report from the nursery/pre-school?	Yes	No

Please give reasons for your application

Try to comment as fully as possible on your child's needs.

Declaration by Parent/Guardian

After full consideration, I wish to formally apply for early entry to Primary school for my child. I accept that this will involve a formal assessment by an Early Years lead and/or a designated staff member from the receiving school.

Name of Parent/Guardian

The information you supply on this form will be used for the purpose for which you have provided it, and appropriate measures are in place to protect your personal data. A full privacy notice, which provides information about your rights under current data protection legislation and details about what will happen to your personal data can be found here: Privacy Notice - Early entry to primary school

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