parent declaration form for translation

Parent Declaration for Early Education Funding

Step 1: Your Child's Details and Eligibility

 

Child's Legal Family Name:

Child's Legal Forename(s):

Name by which the child is known (if different from above)

:

Date of Birth:

 

Gender:

 

Address:

Postcode:

Ethnicity:

First language:

Please tick which document you will provide with this form as proof of child’s date of birth and address:

 

Mandatory

Optional – good practice

□    Birth Certificate

□    Passport

□   Other (please specify)

□    Utility bill

□    Bank statement

□   Other (please specify)

 

2-year-old eligibility code:

(e.g. TYF877-1807-AB1234CD)

Code’s eligibility date:

 

30 hours eligibility code:

(e.g. 50123456789)

Code starts in which term?

Eligible from date:

Eligible to date:

Grace period end date:

Is Step 1 completed?

Step 2: Your Details (parents/carers)

Parent / Carer 1

Parent / Carer 2

Legal Family Name:

Legal Family Name:

Legal Forename:

Legal Forename:

Date of Birth:

Date of Birth:

NI or NASS Number

:

NI or NASS Number:

Telephone Number:

Telephone Number:

Email address:

Email address:

Is Step 2 completed?

 

Step 3: Your Child’s Eligibility

 

  • Some 2-year-olds are entitled to 570 funded hours a year.
  • All 3 and 4-year-olds are entitled to 570 hours a year (universal entitlement).
    • Some 3 and 4-year-olds from working families may be entitled to an additional 570 hours (extended or 30 hours entitlement) a year.

See note 1

Disability Access Fund

If your child is 3 or 4, is receiving child Disability Living Allowance and is receiving Early Education Funding, he or she is eligible for the Disability Access Fund (DAF). DAF is paid to your child’s early years provider. The purpose of DAF is to support providers to make reasonable adjustments and build the capacity of their setting to support children with disabilities. See note 2 on page 6.

Is your child eligible for and in receipt of Disability Living Allowance(DLA)? Yes/No

If yes please provide evidence of DLA start and end date e.g. DWP notification letter

Early Years Pupil Premium

Additional funding may be available through the Early Years Pupil Premium (EYPP), paid to early years providers for the provision of extra support for your child. EYPP is used to improve teaching and learning facilities and resources so as to impact positively on your child’s progress and development. See note 3 on page 6 or speak to your childcare provider.

Is your child currently looked after by a local authority, adopter or has left care under special guardenship/a child arrangement order  

Step 4: Document Check

To be completed with assistance from your chosen provider(s)

Documentary proof of DoB

(e.g. Birth Certificate, Passport)

:

 

Document recorded by

(name of staff member):

 

Date document recorded

(dd/mm/yyyy):

 

DLA Start Date (dd/mm/yyyy)

:

 

DLA End Date (dd/mm/yyyy):

 

 Is step 4 complete? 

 

Step 5: Setting and Attendance Details

To be completed with assistance from your chosen provider(s)

 

  •  You need to agree and complete this Declaration Form with each setting your child attends for their early education entitlement of 15 or 30 hours per week in order to ensure that funding is paid fairly between them.
  • For 3 and 4 year olds - your child can attend a maximum of 2 sites in a single day and if your child attends more than 1 setting we will split the funding fairly between the settings.
  • For 2 year olds – your child can attend 1 setting only.
  • Your commitment to your child’s consistent attendance at their placement is of the utmost importance. In the event that your child cannot attend their sessions for any reason (illness etc.), you must telephone the setting to inform them of your child’s absence. You may be contacted by a member of the Early Help Team to support you and your child back into placement. Ultimately, poor attendance may result in the placement being withdrawn.
  • Children are expected to attend the same setting for the whole of the term and can only move to a different setting part way through the term in exceptional circumstances. Requests to move partway through the term will need to be submitted to the Early Education Funding Manager at EEFTeam@warrington.gov.uk with your child’s name, setting name and clear reasons for the move. Please note: the request to move cannot be guaranteed.

 

My child is attending the following settings (please list all settings attended):

 

 

To be completed by the PARENT/CARER

To be completed by THE SETTING

with the PARENT/CARER

 Setting Name

 

 

 

Total actual hours attended per week

Please enter total number of Early Education Funding hours attended per day

Total number of funded hours

per week

Number of weeks per year (e.g. 38,

45, 51)

Annual funded hours = Funded hours per week x Number of weeks

Mon

Tue

Wed

Thurs

Fri

A

 

 

 

 

 

 

 

 

 

 

B

 

 

 

 

 

 

 

 

 

 

C

 

 

 

 

 

 

 

 

 

 

Total Daily Funded Hours Attended

 

 

 

 

 

 

 

 

 

 

 Is Step 5 completee

 

 

If your child is splitting their entitlement across two or more settings please nominate the main setting where the local authority should pay the DAF and the universal hours:


 


 

Step 6: Parent/Carer/Guardian with Legal Responsibility

 

Data Protection

 

The Data Protection Act 2018 (the Act) puts in place certain safeguards regarding the use of personal data by organisations, including the Department for Education (DfE), local authorities, schools and other early education providers.

 

Warrington Borough Council maintain a database in respect of early education funding. All personal information provided on this form is treated in strict confidence in accordance with the requirements of the Act.

 

In collecting your data for the purposes of checking your eligibility for the 2-year-old, or 3 & 4-year-old universal and extended Early Education Funding, Early Years Pupil Premium (EYPP) or Disability Access Fund (DAF) (see page 6), Warrington Borough Council is exercising the function of a government department. Warrington Borough Council is authorised to collect this data pursuant to Section 13 of the Childcare Act 2006.

 

The data may be shared with other Families and Wellbeing Departments within the Council, other Local Authorities, the DfE, the HMRC, the DWP and other government bodies as appropriate for the purpose of processing Early Education Funding and the identification of children attracting pupil premium funding.

 

You can find out more information on how the Council will handle your information in relation to this application for Early Education Funding at https://www.warrington.gov.uk/privacy_policy.

 

Early Education Providers have also been asked to handle sensitive personal data appropriately, particularly when seeking information about whether a child is in receipt of DLA. They should also pay particular note to the advice from the Information Commissioner's Office on holding personal data including sensitive personal data.

 

Early Education Providers will have their own privacy notice, a copy of which should be available to you.

 

Should you have any concerns relating to the processing of personal information for you, your child or children, please contact your provider or the Early Education Funding Team at EEFTeam@warrington.gov.uk.

 

Declaration

 

 

 

Declaration: I (name)                                                                                                                                                            

of (address)                                                                                                                                                         

 

 

 

  • understand that if I knowingly or fraudulently claim more than the maximum hours allowable, I will be liable for any loss incurred by the Government, Local Authority or Provider(s) named on page 3
  • confirm that the information I have provided above is accurate and true

 

 

I understand and agree to the conditions set out in this document and I authorise

(Name ofProvider/s)                                                                                                                                                            
  • to claim funding as agreed above on behalf of my child.

 

 

Parent/Carer/Guardian with legal responsibility

Childcare Provider

Signed

 

Signed

 

Print name

 

Print name

 

Date

 

Date

 

 


 

This form is now complete

Parent Notes

 

Eligibility Criteria for Early Education Funding

Note 1: eligibility criteria for Early Education Funding for 2- 3-and 4-year-old children can be found online at https://www.childcarechoices.gov.uk/

 

Note 2: 3- and 4-year-old children who are in receipt of child Disability Living Allowance (DLA) and are receiving funded early education are eligible for the Disability Access Fund (DAF). DAF is paid to the child’s setting as a fixed annual sum of £615.

 

Note 3: Early Years Pupil Premium (EYPP) is an additional sum of money paid to childcare providers for 3- and 4-year-olds of families in receipt of certain benefits including:

  • Income Support / Income-based JSA / Income-related ESA
  • Support under Part VI of the Immigration and Asylum Act 1999
  • the guaranteed element of State Pension Credit
  • Child Tax Credit (provided you're not also entitled to Working Tax Credit and have an annual gross income of no more than £16,190)
  • Working Tax Credit run on - paid for 4 weeks after you stop qualifying for Working Tax Credit
  • Universal Credit - For places starting in the summer term of 2018 (on or after 1st April 2018), or any subsequent term, if a parent is entitled to Universal Credit they must have an annual net earned

income equivalent to and not exceeding £7,400, assessed on up to three of the parent’s most recent Universal Credit assessment periods

  • Child is Looked After by a local authority, has left care through Adoption, Special Guardianship or Child Arrangement Order. (a copy of the certificate will be required to evidence this)

 

For more information please speak to your childcare provider or email the Early Education Funding Team on EEFTeam@warrington.gov.uk.

 

Please note the criteria listed above may change and is dependent on guidance from the Department for Education (DfE).