APPLICATION FORM

SUPERVISED LEARNING: The Department of Education (N.I) has clarified that Key worker children will have ‘supervised learning’ in school, completing the same activities as those involved in remote learning. Please note that this is not traditional face to face teaching as in a standard school day. SCHOOL PROVISION FOR THE CHILDREN OF KEY WORKERS, THOSE WITH A STATEMENT OF SPECIAL EDUCATIONAL NEED OR OTHER VULNERABILITY.

I wish to apply for a place as (please delete as appropriate):
- I meet the ‘Key worker’ definition and require a place for my child(ren)
- My child has a Statement of Special Educational Need or is vulnerable

Name of Pupil 1:	Class:
Name of Pupil 2:	Class:
Name of Pupil 3:	Class:

Parent 1 Occupation:	Contact Number:
Parent 2 Occupation:	Contact Number:

Explain your individual circumstances and reasons why you feel provision for your child/children should be provided by Kirkistown Primary School. Please include other childcare options explored:

Proposed work schedule/hours requested: Please note that school will operate normal hours (all year groups finish at 2pm on Fridays) There is NO KIDS CLUB option available.
MONDAY	TUESDAY	WEDNESDAY	THURSDAY	FRIDAY

Please also note the following:

School respectfully asks that that parents and carers only avail of this service where absolutely necessary.

Your application for childcare provision / ‘supervised learning’ is not acceptance. The Principal will inform you of acceptance/decline.

As outlined, this will not be a normal school day. Families should not expect face to face teaching as teaching staff will also be involved with managing remote learning for those at home. School dinners will not be available and typical procedures such as Classroom Assistant cover if your child has additional needs cannot be guaranteed.

Pupils could potentially be the only child in their classroom.

Pupils should wear school uniform, bring a coat and a packed lunch and snacks (NO NUTS or food containing nuts).

Thank you again for your understanding and your commitment to explore every other option available to you BEFORE applying for this provision. I hope that we can all stay safe and work together in these troubling times.

R. Graham

Principal