Form

First name*

Last name*

Email*

Child Full Name*

Child Date of Birth*

Day/Month/Year

Location of Interest*

Service of Interest*

Workplace Nursery Scheme Amount*

Please advise how much you intend to be paying in via Workplace Nursery scheme each month. Note that this amount will be credited against the invoices raised on your account, and will stand as a liability for you to repay if we do not receive these funds from your Workplace Nursery Scheme provider

Workplace Nursery Scheme Benefits Provider*

Please advise which workplace nursery benefits provider you intend to use so that we can track payments on an ongoing basis

Workplace Nursery Contract Start Date*

Please advise when you would like the workplace nursery scheme payments to initiate so we can update the invoices accordingly. Please note, this will be affected, at the earliest, 4 weeks from the submission of this form

Day/Month/Year

Workplace Nursery Contract End Date

If you're aware of when you will expire your workplace nursery scheme, please advise when you expect to return to paying the fees in full directly yourself

Day/Month/Year

Payment Terms Compliance*

I confirm that I have set up the above payment to be issued to Hatching Dragons on the 1st of each month to pay for the childcare period one month ahead, in line with the school's payment terms and acknowledge that if these funds are not secured, the administrative surcharge of £25 will be applied against the account in line with the late fees policy and the companies terms and conditions

Yes