Form

First name*

Last name*

Email*

Child Full Name*

Child Date of Birth*

Day/Month/Year

Location of Interest*

Service of Interest*

Universal Credit Amount*

You may be able to claim back up to 85% of your childcare costs if you’re eligible for Universal Credit. Universal credit allows you to claim £1,014.63 for one child or £1,739.37 for 2 or more children depending, meaning that you will always be obligated to pay the 15% difference between the fees and the maximum threshold that can be claimed back. Please only input the amount of money you know Universal Credit will pay on your behalf - not the funds you can / will claim back. Families who are deemed to be at risk can have their fees paid by Universal Credit and we're asking only those who know that U/C will pay to input the amount here.

Universal Credit Reference

Please input the payment reference for Universal Credit payments should you have one so we can track payments against your account

Universal Credit Start Date*

Please advise when you would like the Universal Credit 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

Universal Credit End Date

If you're aware of when you will expire your Universal Credit support, 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