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 Parent/Carer Declaration Form & Agreement for


 Please tick all that apply to you:


 Sessions

Below are the calculated hours for each day session that your child can attend:

 Child Details

 Parent/Carer Details 1

 Parent/Carer Details 2

 Pick Up Consent: Your consent is required for other people to collect your child from the nursery on your behalf.


 Parent/Carer Declaration Form & Agreement for


 Please tick all that apply to you:


Terms and conditions of application for a Nursery/Childcare place:

Please tick to show that you understand and agree with the following conditions for your child’s nursery/childcare place.


 Terms & Conditions: Only applies to NON FUNDED places

  • 1. Please complete this form and return it together with a £50 non-refundable registration fee to secure a nursery place. Cheques should be made payable to ‘Mini Miners Nursery School.’
  • 2. A non-refundable registration fee of £50 is required to secure a nursery place
  • 3. I understand the deposit will be calculated on a 2 weeks basis and is refundable. This requires three months’ notice in advance and after all dues is cleared.
  • 4. Nursery fees are invoiced on a monthly basis and are payable in advance.
  • 5. Fees are calculated over 38/51 weeks and are divided into 12 equal monthly payments.
  • 6. Our preferred method of payment is by standing order, but we also accept BACs payments, nursery vouchers, debit card payments, and cash payments.
  • 7. Late payment of fees will incur a penalty charge of £50.
  • 8. In the event of late collection, additional time is charged at the hourly rate. If your child attends for additional sessions during a month these will be added to your next monthly invoice.
  • 9. We are sorry, but we are unable to provide a refund in the event that your child misses a session.
  • 10. TWO YEAR CHECK – Please inform the Mini Miners Nursery School if you have completed a two-year check – either with your health visitor or with another nursery.

 Payment Policy:

  • • We aim for our setting to be realistic and flexible with our fees and payment policy whilst being competitive in the nursery market place; however, it is necessary in our nursery to have set guidelines so we are all clear of our expectations.
  • Our registration fee of £50 will be required to secure your place.
  • • Upon leaving the nursery four weeks written notice is needed to cancel this contract and to pay for all sessions during the four-week notice period. If you leave before the notice period ends you will still be liable for the fees during this period.
  • • Four weeks written notice is also required to increase or decrease sessions.
  • All fees/meals should be paid in full for the week/month in advance. Cash, card, cheque or standing order (to be setup with the finance department). Breakfast: £2.50 Morning/Afternoon Snack: £2 Lunch: £2.50 Tea: £1.50 Total: £8. Pyjama Drama Class £3.50 Ballerina Class £3.50
  • Late collection of children past their session times will incur a charge of £10 per fifteen minutes of lateness as will starting before the pre-booked session times.
  • • If fees are in arrears by 14 days the bursary has the right to suspend the place until such arrears are paid in full. If after 28 days payment has not been received then the registration will be cancelled which will include the 4 weeks’ notice period.
  • • Debt collection proceedings will be commenced to recover all monies owing, starting with the institute’s finance department and may include the use of an external debt collection agency.
  • • Once your child has been registered with us you will be invoiced for the sessions you have booked for your child until we receive your written notice, as these are classed as permanent bookings.
  • • All missed sessions including child illnesses are payable in full.
  • • 30 hours fee payment information policy is attached.

The nursery operates alongside comprehensive policies and procedures collated in consideration of good practice and the ‘Statutory Framework for the Early Years Foundation Stage’.

These policies and procedures are available upon request. It is recommended that parents read these policies and procedures; particularly in consideration of safeguarding children


 Consent: Please Tick


 Early Years Pupil Premium (EYPP)

The EYPP is a new government scheme created to give nurseries and schools a bit of extra money/funding for each eligible child. This funding goes to the school directly to help them offer children what they need to get on with their education such as additional training for staff, equipment, supplies, books for the library etc.


 Only complete the information below if it applies to you.

 Adoption, special guardianship order or child arrangements order

If your child has left care through adoption, special guardianship or a child arrangement order please answer below and attach a copy of the relevant court order so that you can apply for the EYPP.


Parent/Carer Declaration

The information I have given on this form is complete and accurate.

I understand that my personal information will be held securely and used only by Ealing Council and my child’s nursery/childcare provider for the purposes of checking my child’s eligibility for the nursery/childcare place, EYPP and any other funding scheme my child may benefit from.