Childcare Work Placement Form

This form should be completed if you are undertaking a work placement as part of your course and therefore need additional childcare.

Once you have completed this form, the college will contact your childcare provider for confirmation of their fees. When your application has been assessed, you and your childcare provider will receive notification of the outcome via email.

Your Personal Details

Student ID Number (if you know it)

Name*

Forename Surname

Date of Birth*

Home Address

Street Address Address Line 2 City ZIP / Postal Code

Contact Number*

Email*

Childcare Support Required

Child 1 Name*

Date of Birth*

Childcare sessions required for the days you attend work placement

Child 2 Name

Date of Birth

Childcare sessions required for the days you attend work placement

Adding additional child

True

Child 3 Name

Date of Birth

Childcare sessions required for the days you attend college:

Childcare Provider Details

Chlildcare Provider Name*

Address*

Street Address Address Line 2 City ZIP / Postal Code

Contact Number*

Email Address*

Work Placement Details

Workplace Name*

Workplace Address*

Street Address Address Line 2 City ZIP / Postal Code

Contact Name*

Contact Number*

Start date of work placement*

End date of work placement*

No. of days per week

Please enter a number from 0 to 7.

Terms and Conditions

Please read the Childcare Subsidy Terms and Conditions carefully. If there are any points requiring clarification, please contact Student Services on 01772 225656.

Learner Declaration and Consent

If any of the information you have provided in support of this application is found to be inaccurate, or deliberately misleading, the situation will be dealt with under the Student Disciplinary Procedure and you will be required to repay any payments received.

I agree to the privacy terms and conditions and the college’s privacy policy.*

I confirm I have read and understood the Childcare Subsidy Terms and Conditions.*

I give consent for the college to contact my childcare provider as necessary.*