Parental Declaration Form for Free Early Education Entitlement (FEEE)

Setting Details * Please select the nursery setting you attend below

Child Details

First name *

Surname *

Middle name(s)

Preferred surname

Date of birth *

Gender *

Ethnicity

Present During EY Census:

Parent Details

Parent/Carer 1 Name *

Parent/Carer 1 DOB *

Parent/Carer 1 NI Number *

Parent/Carer 2 Name

Parent/Carer 2 DOB

Parent/Carer 2 NI Number

Child's home information

Building name/no *

Street *

Town/City *

Postcode *

Email Address

Telephone

9 months to 23 months old (inclusive) of working family and all 2 year old FEEE

To access 9 months to 23 months old (inclusive) of working families and all the 2-year-old FEEE your child must meet the eligibility criteria, as confirmed by your Eligibility or Early years vouch code. * Please enter below the Eligibility code or Early years voucher code for your child.

FEEE Additional 15 hours Entitlement (3 & 4 year olds)

To access the 15 hours per funded week FEEE Additional Entitlement for your 3 or 4 year old, you must have applied for an Eligibility code via the HMRC's Eligibility code application and confirmed your eligibility with your childcare provider. * HMRC's Eligibility code application

Please indicate below if your child meets the criteria and input your voucher code.

Yes

Early Years Pupil Premium (EYPP)

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 and accessing 2-, 3- and 4-year-old FEEE. This funding will be used to enhance the quality of their early years' experience by improving the teaching and learning and facilities and resources, to impact positively on your child's progress and development.

By signing this form, you consent to an eligibility check for EYPP.

Disability Access Fund Declaration

Three- and four-year old children who are in receipt of child Disability Living Allowance (DLA) 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 £881 per eligible child. Please supply evidence of DLA to your provider.

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

Yes

Attendance details

- You need to agree and complete this Declaration Form with each setting your child attends for their FEEE entitlement (Eligible 9-month-olds to 2-year-olds), FEEE Universal entitlement (Eligible 3&4-year-olds) or FEEE Additional entitlement (Eligible 3/4-year-olds only) at least once per year (Financial Year April-March) in order to ensure that funding is paid fairly between them.

- The entitlement per annum (Apr-Mar) is 570 hours for all ages plus, if eligible, 570 hours Additional Entitlement for 3- & 4-year-olds. Please speak to your childcare setting about the FEEE sessions they operate (hours and days). These should be detailed on your contract with them, and via child registers.

- Your child can attend a maximum of two sites (refers to provider postcode) in a single day. It is the parent's decision how the funding is allocated between all providers who offer both FEEE Entitlement and Additional FEEE Entitlement. However, if one of the Providers only offers FEEE entitlement funded places, that Provider must inform the parent prior to the child taking up the place that they will claim FEEE Entitlement only.

My child is claiming FEEE with this setting from

Claim Start Date * This current terms claim start date is: 15/04/2024

Claim End Date * This current terms claim end date is: 31/08/2024

My child is attending the following settings for the FEEE Entitlement for eligible 9-month-olds to 2-year-olds or the Universal FEEE Entitlement for 3&4-year-olds: *

Number of hours with Brook Babes: * Guidance: 195 Hours if attending 10 hours or more. Unless splitting between another setting. If this is the case please contact our offices on 01677 460101.

Other Setting Name:

Number of hours claimed at Other Setting:

Additional hours above FEEE entitlement for eligible 3 & 4 year olds: Guidance: If attending Brook Babes 2 days or more input 195 hours. If less this would be "Nil".

If your child attends any hours above the Universal or Additional FEEE, please indicate this here: * Guidance:
- If your child is funded for 15 hours only, 2 days attendance would equal 5 hours, 3 days would equal 15 hours, 4 days would equal 25 hours & 5 days would equal 35 hours.

- If your child is funded for 30 hours, 4 days attendance would equal 10 hours & 5 days would equal 20 hours.

If your child is splitting their free entitlement across two or more providers, please nominate the main setting where the local authority should pay the DAF/EYPP (this should be the provider claiming universal entitlement):

Parent/Carer/Guardian with legal responsibility declaration

Declaration (Name) *

Building name/no *

Street *

Area *

Town/city *

Postcode *

Agree to conditions * I/We 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 of Provider/s). to claim free entitlement funding as agreed above on behalf of my child and inform me which funding streams my child is eligible for.
In addition, I also agree that the information I have provided can be shared with the local authority and Department for Education, who will access information from other government departments to confirm my child's eligibility for 2 year old FEEE or the FEEE additional Entitlement and enable this provider to claim Early Years Pupil Premium (EYPP) or Disability Access Fund (DAF) on behalf of my child.

Parent/Carer/Guardian Signature *

Please check box for digital signature.

Brook Babes Limited

Register Interest