1. Childcare Application Form
Child’s full name:
Date of birth:
Sex:
Child’s address and phone number:
Parent/ Guardian 1
Parent/ Guardian 2
Name:
Address and phone number:
address:
Circle the appropriate Nursery & Session type
Butterfly Nursery
Hove Poly Clinic
Neville Avenue
Hove
East Sussex
BN3 7HY
Hilltop Nursery
Brighton General Hospital
Elm Grove
Brighton
BN2 3EW
ext. 3302
Rainbow nursery
Crawley Hospital,
West Green Drive,
Crawley
West Sussex
RH11 7DH
ext. 3790
Sessional childcare
Free Play ‘n’ Stay
Free funded childcare
Drop ‘n’ Go hours
Holiday Fun
Nursery Forest Fun (ask nursery for dates)
Any data collected on this form will be used to contact you if a place is available.
We collect and use children’s information under the Education Act The EU general data protection regulation 2016/679 (GDPR) will take effect in May including Article 6 ‘lawfulness of processing’ and Article 9 ‘Processing of special categories of personal data’

2. Email - sc-tr.sctnursery@nhs.net
Required childcare
If you only need the same childcare each week only fill in the top boxes.
For Flexi Childcare Fill in 4 weeks and discuss your requirements with the Nursery Manager
Week required
Monday
Tuesday
Wednesday
Thursday
Friday
Hours required -