Parent Declaration for Free, EE2, EE3 and 30 Hours Entitlement

Parent declaration for the entitlements

"*" indicates required fields

Step 1 of 3

33%

Child's Details

Child's Legal Family Name:*

Child's Legal Forename(s):*

Name by which the child is known (if different from above):

Date of Birth (dd/mm/yyyy):*

Day

Month

Year

Gender:*

Address:*

Street Address Address Line 2 City ZIP / Postal Code

9 month+ funding working parents, if applicable, please enter 11 digit eligibility code

2 year old funding disadvantaged - approval certificate, EY reference number or manual approval date, if applicable

2 year old funding working parents, if applicable, please enter 11 digit eligibility code

30 hours Funding for eligible 3 and 4 Year olds, if applicable, please enter 11 digit eligibility code

Note: All children are entitled to 15 hours funded entitlement from the term after the 3rd birthday. Proof of date of birth must be given above.*

Acknowledged

Nursery Attending*

Parent/Carer Details

Legal family Name:*

Legal forename:*

Parent/Carer 1 Date of Birth (dd/mm/yyyy):*

Day

Month

Year

Parent/Carer 1 NI or NASS number

Legal family Name:*

Legal forename:*

Paren/Carer 2 Date of Birth (dd/mm/yyyy):

Day

Month

Year

Parent/Carer 2 NI or NASS number

Early Years Pupil Premium (EYPP) Registration Form

Additional annual funding of £ 388 may be available through EYPP, paid to providers for the provision of extra support for children of families in receipt of certain benefits (see criteria and online checker details in additional information). Children who are looked after or have left care of the local authority through adoption or special guardianship are also eligible. Children may now be eligible for EYPP if accessing any early years funded entitlement and it should be used to improve teaching and learning facilities and resources to as to impact positively on your child’s progress. Do you wish your provider to apply for EYPP? This check will use the information supplied by you on this form or you may need to provide evidence such as a copy of an adoption certificate or a copy of the special guardianship/residence order.*

Yes please arrange an EYPP check

No thanks

Additional Information - EYPP

Criteria and application details at www.newham.gov.uk/eypp

I acknowledge

Disability Access Fund Declaration

Is your child eligible and in receipt of Disability Living Allowance (DLA)?*

Yes

Children who are in receipt of child Disability Living Allowance and are receiving the free entitlement are eligible for the Disability Access Fund (DAF). DAF is paid to the child’s early years setting as a fixed annual rate of £910 per eligible child. The purpose is to allow providers to make reasonable adjustments and build the capacity of their setting to support children with disabilities.*

Yes - Please supply a copy of award letter to allow Early Start to submit

Copy of Award Letter

Max. file size: 10 MB.

If your child is splitting their free entitlement across two or more providers please nominate the main setting where the local authority should pay the DAF:*

Ethnic Origin

Ethnic Origin – please help your provider to complete the Department for Education Early Years Census by indicating you child’s ethnic origin below:*

Declaration: I confirm that the information I have provided above is accurate and true. I understand and agree to the conditions set out in this form and I authorise Early Start Education Ltd to claim free entitlement funding as agreed on behalf of my child. I confirm that my child is attending the above provider for the specified funded hours per week per funding period.*

Providing false information or withholding information which results in illegitimate access to funded early education or other public funds is fraudulent and may be investigated by the Local Authority.

If you leave your provider you need to give them 4 week’s notice you cannot start a new funded place until after this time

I Confirm

Parent/Carer/Guardian with Legal Responsibility Forename*

Parent/Carer/Guardian with Legal Responsibility Surname*

Parent/Carer Signature*

Date (dd/mm/yyyy)*

Day

Month

Year

Data privacy

In collecting your data for the purposes of checking your eligibility for the 2 year old, or 3 & 4 year old universal and extended entitlements, Early Years Pupil Premium (EYPP) or Disability Access Fund (DAF), Newham is exercising the function of a government department. Newham is authorised to collect this data pursuant of Section 13 of the Childcare Act 2006.
Newham council is the data controller for purposes of the EU General Data Protection Regulation and any UK laws supplementary to this, and is registered as a data controller with the Information Commissioner’s Office (ICO) under registration number Z5808736.

Newham council is committed to protecting your personal information. As a data controller we have a responsibility to make sure you know why and how your personal information is being collected in accordance with relevant data protection law.
Why we are processing your data - We are collecting your data for the purpose of
• enabling us to pay your early years provider for their provision of the early years free entitlement for your child, including for any supplementary entitlements
• supporting your child’s teaching and learning
• monitoring early years and childcare provision

We have a legal basis for collecting this data as we have a legal obligation under the Childcare Acts 2006 and 2016. We will process special category data regarding your child’s ethnicity, disability (where applicable) and this will be done on the basis of Substantial Public Interest: processing is necessary for reasons of substantial public interest, on the basis of Union or Member State law, which shall be proportionate to the aim pursued. Data may be used in accordance with the Equality Act 2010.

Your anonymised data may be shared with Newham Children’s services, and the government’s Department for Education for statistical purposes.

We will hold your data for six years’ following the term after your child's fifth birthday.
Your information rights
• You have the right to access a copy of the data held about you and your child and an explanation of the purpose for it.
• If you believe that information held is inaccurate, you have the right to request that it be changed.

Further information - If you wish to exercise any of your information rights, please refer to Newham’s data protection privacy statement which is located here https://www.newham.gov.uk/Pages/Services/Processing-personal-data.aspx

The Data Protection Act 2018 (the Act) puts in place certain safeguards regarding the use of personal data by organisations, including the Department for Education, local authorities, schools and other early education providers. The Act gives rights to those about whom data is held (known as data subjects), such as pupils, their parents and teachers. This includes:
• The right to know the types of data being held
• Why it is being held; and
• To whom it may be disclosed
Should you have any concerns relating to how your information or the information relating to your child/ren is being or will be used, please contact your provider or Newham Council. Please note that information about whether a child is in receipt of Disability Living Allowance is, under the Act, Special Category Data which should be handled appropriately. Providers are asked to pay particular note to advice from the Information Commissioner’s Office on holding personal data including sensitive personal data available at:
https://ico.org.uk/for-organisations/guide-to-data-protection/principle-3-adequacy/

I acknowledge the Data Privacy notice

Signed