Kintore Way Children's Centre

Application Form

You can apply for a place for your child using the form below.

Once your application form has been submitted, we will need to see the original copies of your child’s birth certificate and a proof of address for your child (please refer to application form for examples).

We will make copies of the documents and return it to you.

Please note that if you are applying for a 2 year old FREE place you will also need to provide us with your confirmation letter from Southwark Council stating that you are eligible for a free 2 year old place.

Your application will processed on the basis that these documents will be provided but failure to do so may affect whether or not your application is successful.

You can also download a copy of the application form 2-5 Years Application Form

1. Type of placement required

I am applying for (please select your prefered option)

(If, for any reason, we are unable to offer you a 2 year old place you will automatically be placed on our 3 year old waiting list.)

ADDITIONAL DOCUMENTS NEEDED: Child’s original birth certificate and proof of child’s address (e.g. medical card, child benefit letter, tenancy agreement etc.)

Please note that if you are applying for a 2 year old FREE place you also need to provide us with your confirmation letter from Southwark Council stating that you are eligible for a free 2 year old place..

2. Child's details


3. Parental Responsibility

First adult with parental responsibility


Second adult with parental responsibility


4. Siblings

Please give details of any siblings that attend/have applied or have attended Kintore Way:

Sibling One



Sibling Two


5. Special Educational Needs

Does your child have any Special Educational Needs (including any speech and language concerns)?

If so, please give details (including names of therapists) below:

6. Medical Needs

Does your child have any medical and / or social needs?

If so, please give details below and attach any supporting documents to this form:

7. Current Nursery

Does your child already attend a nursery?

If so, please give details below (please note: the government funded 15 hours for 2/3 year olds can only be taken advantage of in one nursery. Therefore if you accept a place at Kintore Way, you must not accept government-funded nursery education anywhere else):

8. Preferences

Do you have a preferred room/class or key person you would like your child to have?

If so, please give details below:

9. Parent or Carer work/study hours

If applicable, how many hours per week are you / will you be working or studying?

1st Parental Responsibility:


2nd Parental Responsibility:


10. Benefits

Do you receive any of the following benefits?









11. Ethnic Background

Our ethnic background describes how we think of ourselves.

This may be based on many things including, for example, our skin colour, language, culture, ancestry or family history. Ethnic background is not the same as nationality or country of birth.

Please study the list below and select one box only to indicate your child’s ethnic background.

12. Language and Religion

13. Home visits

If your child is offered a place, a home visit will be arranged with your key person before your child starts. Please indicate below if you do not speak English and would require an interpreter at your home visit:

14. Anything else?

Click Submit to complete your application.