[D]

Initial application form

This application only acknowledges your initial interest for childcare. A place cannot be guaranteed.

Child's name
Child's date of birth/due date
Parent(s) names
Contact address
Contact e-mail address
Contact phone number

Are you/will you be		a Sheffield Hallam University student a member of Sheffield Hallam University staff not connected with Sheffield Hallam University

Please specify (if known at this time)
	Course (University students)
	Department (University staff)
	Place of work (not connected with the University)

If you are a student, please specify:
	Course start date (MM/YY)
	Course length (number of years)

From when would you like a place in the nursery? (MM/YY)

Which nursery sessions will you need? (if known at this stage)
	Morning	M T W TH F
	Afternoon	M T W TH F

Does your child have any:
	Special educational needs	Yes No
	Special diet	Yes No
	Allergies	Yes No
	Medical conditions	Yes No

Contact us

Sheffield Hallam University Nursery
23 Broomgrove Road
Sheffield
S10 2LW

Phone 0114 225 2263
Fax 0114 225 2513
E-mail childcare@shu.ac.uk