To register your interest in, and get a place at, our nursery please complete the form below as soon as possible. Once we have received your completed form we will be in touch as soon as a place becomes available. 1. Your details Child's name Date of birth / expected date of birth Parent/Guardian's name Relationship to child Address Address Line 1 Address Line 2 City County Postcode Country Telephone number Email Which of the following are you Staffordshire University staffStaffordshire University student or SURF studentNon-university Date I wish my child to start at nursery Please include any other information about your child (dietary requirements, medical information etc.) 2. Sessions required Monday Please select None required Morning (8:15 to 13:15) Afternoon (12:45 to 17:15) Full day (08:00 to 18:00) Tuesday Please select None required Morning (8:15 to 13:15) Afternoon (12:45 to 17:15) Full day (08:00 to 18:00) Wednesday Please select None required Morning (8:15 to 13:15) Afternoon (12:45 to 17:15) Full day (08:00 to 18:00) Thursday Please select None required Morning (8:15 to 13:15) Afternoon (12:45 to 17:15) Full day (08:00 to 18:00) Friday Please select None required Morning (8:15 to 13:15) Afternoon (12:45 to 17:15) Full day (08:00 to 18:00) If your child is 3 they may be entitled to free Education Funding. If you wish to access a free place only, tick this box. 3. How you found us How did you hear about the Staffordshire University Nursery? Searched the University websiteSearched the internetSuggested by University staffSuggested by friend/familySaw the nursery advertisedAttended an open dayOther If you chose 'other', please give details of how you heard about the nursery: Disclaimer Staffordshire University ensures information is stored and handled in accordance with the data protection law. Please read our data protection policies for more details. Request a place