Consent Form & Term Fees – Pangbourne House

Autumn Term 2024

New or Returning Child*

New Child
Returning Child

Child's Name*

First Last

Nickname if applicable

Nickname

Date of Birth*

Email*

Enter Email Confirm Email

Consent Form

School Dog*

I approve of Liffey being with the children under careful supervision of a responsible adult.

Liffey is the school dog at Pangbourne House. She is well-trained, obedient, docile, affectionate, clean and routinely vaccinated. Liffey is kept in the office; when she is in the classrooms she is always supervised by an adult. Likewise, under supervision, the children are given the opportunity to hold her lead and walk her in the park.

Unique Password for Child Pickup*

We would like to emphasise that without this password we will not be able to pass your child over to an adult unknown to us.

Photography / Video

Photographs or video footage of my child to be used for school use i.e. teacher observations or class displays. Also for other parents to take photographs or video footage during school events like plays and sports days, etc

I give permission

Social Media

Please be aware that we post photographs of what the children have been doing on Instagram and Facebook. We never show the children’s faces. Please indicate if you agree with this.

I agree

Transport

I agree to my child using public transport or a parent / teacher’s car for school trips.

Health & Allergies

Please answer the following questions about your child's health.

Please select the immunisations your child has had

Does your child suffer from ECZEMA?*

Yes
No

Does your child suffer from ASTHMA?*

Yes
No

Does your child suffer from any ALLERGIES?*

Yes
No

Please state any Health Issues or Allergies your child may have*

If your child is on a course of medicine that he/she needs to take at school please ask your teacher for the appropriate medication form.

Sunscreen

I agree to my child having sunscreen put on when necessary (you must provide your own).

Doctor

Should it be necessary, I agree to my child being seen by a health visitor or doctor at school, or to be seen at the local hospital, as long as my child is accompanied by a teacher. I also give my permission for my child’s doctor to be telephoned in case of emergency.

I agree

Doctor's Name or Surgery

Doctor's Telephone

Term Fees – New Child

Term Fees - New Child

Mornings: 9am – 12noon | Full Days 9am – 3pm*

Preferred Days - New Child

Select Full Days*

Monday
Tuesday
Wednesday
Thursday
Friday

Preferred Mornings - New Child

Select Mornings*

Monday
Tuesday
Wednesday
Thursday
Friday

Extras – New Child

Extras

Ballet – Tuesdays, 11.20am
Yoga – Mondays, 2pm
Spanish – Tuesdays, 20min, 2pm

Term Fees – Returning Child

Term fees - Returning Child

Mornings: 9am – 12noon | Full days: 9am – 3pm*

Preferred Days – Returning Child

Select Full Days*

Monday
Tuesday
Wednesday
Thursday
Friday

Extras - Returning Child

Extras

Ballet – Tuesdays, 11.20am
Yoga – Mondays, 2pm
Spanish – Tuesdays, 20min, 2pm

Term Fee Payment

Total

£ 0.00

Please transfer the total amount to the bank details below and indicate that you have completed the transfer.*

I have completed the bank transfer

Bank transfer to: Pangbourne House Ltd, Acc. No.:69375550 Sort Code: 60-15-33 (please use child's name as reference)
A term's written notice is required before the removal of pupils; otherwise parents are liable for fees in lieu of notice.
All Fees are non-refundable.
Fees are subject to annual review and are subject to change.

Signature & Consent

Digital Signature*

Please enter your name

Registration Date*

Data Protection Consent*

I confirm that by submitting this form, I agree to Pangbourne House keeping the personal details stated above.

We take your privacy seriously and will only use your child's / your personal information to maintain our internal records or to contact you by the means that you indicate above.

Email

This field is for validation purposes and should be left unchanged.

Autumn Term 2024Online Consent Form & Term Fees