Nursery Application Form


Lilliput Lodge Day Nursery
The special P L A C E for your child
Professional, Learning and Caring Environment

4 Waterside Business Park, HESSLE HU13 0EG Tel: 01482 606645

10 Sykes Street, Freetown Way, HULL HU2 8AZ Tel: 01482 606645

Please circle one or both nurseries where you would like a place:       HULL       HESSLE


Registration Fee = £35.00 (non-refundable) includes 2 pre-visits!
PLEASE SEND WITH COMPLETED APPLICATION FORM

Child's Name:

Date of birth:
Address:
Telephone Number:

Mother's Name:

Workplace:
Father's Name:

Workplace:
What type of placement do you require?

Full time:

Part time:

Placement Days required:

Start date required:

Emergency contact number (other than those stated above)

1 .................................................
2 .................................................
3 .................................................

Any special information:
I agree to the Lilliput Lodge Day Nursery Terms and Conditions stated (a copy of which is set out below) which I have read and fully understand.

Where did you hear about Lilliput Lodge?

Signed:

Date