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* 1. Pupil Details

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* 2. Pupil Address

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* 3. 30 Hour Eligibility Declaration

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* 4. Current / Previous 30 Hour Claim

Are you currently claiming for 30 Hours Free Childcare in a different setting or have you ever previously made a claim for the child named above?

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* 5. Disability Access Fund Declaration

Three and four year old children who are in receipt of Child Disability 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 £615 per eligible child.

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

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* 6. Early Years Pupil Premium (EYPP) Registration Form)

The Early Years Pupil Premium (EYPP) is an additional sum of money paid to childcare providers for children of families in receipt of certain benefits. This funding will be used to enhance the quality of their early years experience by improving the teaching and learning facilities and resources, with the aim of impacting positively on your child's progress and development. For more information, please speak to our Admissions Officer.

If you believe that your child may qualify for the EYPP, please provide the following information for the main benefit holder to enable the local authority to confirm eligibility.

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* 7. Declaration

By submitting this form, you are confirming that you have read, fully understood and agree to the following declarations:

1. I confirm that the information provided above is accurate and true
2. I understand that if I have given any false or misleading information on this declaration or fail to notify Hillingdon Borough Council of any change in my circumstances or change of address before my child takes up their entitlement, my child's place may be withdrawn.
3. I authorise Deanesfield Primary School to claim free entitlement funding as agreed on behalf of my child.
4. I understand that Hillingdon Borough Council will be carrying out sample checks and I will need to complete the online eligibility check with HMRI prior to July and then again on a three month basis to ensure I meet the eligibility requirements for the 30 hour childcare offer.
5. I understand that I may be asked to produce evidence of my eligibility and that if I am found to be ineligible, the offer of a 30 hour place will formally be withdrawn.
6. I understand that if for any reason the London Borough of Hillingdon are unable to provide the full amount of funding, or that my child is no longer eligible, any additional payments or incurring costs to my child's childcare must be made by myself to Deanesfield Primary School.
7. I understand that my child is entitled to a maximum of 30 hours of free childcare a week over a minimum of 38 weeks of the year (6 hours per day, Mon-Fri, term time only).
8. I authorise Deanesfield Primary School to claim Early Years Pupil Premium or Disability Access Fund on behalf of my child if relevant.

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* 8. By submitting this form, you are digitally signing the paperwork and agree it is accurate.

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