Name your child is known by
Date of Birth
Does your child have any allergies?
Does your child have any medical conditions?
Does your child have any learning difficulties or disabilities?
If known, please select as appropriate
No Special Educational Needs
Early Years Action
Early Years Action Plus
Occupation and workplace
Contact Email address
Please indicate which address the child normally lives at
Who has parental responsibility for the child?
Children's Social Care
Who is the legal contact for the child?
Has your child attended another child care setting?
If yes, please state name and contact details
Will your child attending another setting whilst attending the Pre-School Centre?
If yes, please give contact details
Please specify appropriate category for this application
Member of staff at Lancaster University
Undergraduate student of Lancaster University
Postgraduate Student of Lancaster University
Name of College
Name of Department
Do you require full or part-time care?
If part-time, please indicate the number of sessions required.
(A session is morning or afternoon)
Please indicate a provisional start date
Please note this is an application form only, which will be held on the waiting list prior to a booking form being issued and a place being allocated.
Lancaster University, Bailrigg, Lancaster, Lancashire LA1 4YWTel: 01524 594464