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 = Ł35.00 (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