COVID-19 Additional Payment Form
PLEASE RETURN THIS FORM TO: FIS@derby.gov.uk
This form must only be completed by childcare providers claiming additional FEEE hours for
Critical Worker parents and parents of vulnerable children that have moved from a closed
childcare provider:
Childcare Provider Name:
Childcare Provider Ofsted URN:
Child Name:
Child Date of Birth:
Date child started at your
provision:
Number of weeks you would like to
claim for the child in spring term
2020 (23 March to 20 April)
Number of weekly hours you would
like to claim for the child in spring
term 2020 (23 March and 20 April)
Is the child attending term time or
stretching funding over the year
Name of the childcare provider the
child has moved from due to
closure
Please tick the box to confirm the parent has completed the ‘COVID-19 Part-
Enforced Closures Form’ to evidence they are a Critical Worker parent or parent of a
vulnerable child.
Print Name of responsible person at
the childcare provider:
Signature of responsible person at the
childcare provider :
Date
click to sign
signature
click to edit
dd mmm yyyy
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