Pangbourne House

Online Registration Form

Please fill out the following registration form and transfer £60 to secure your child’s place at Pangbourne House.

Child Details
Child's Name*
First Last
Date of Birth*
Date Format: DD slash MM slash YYYY
Address*
Street Address City Post Code
Home Telephone
Parent Details
Select Parent*
- Mother
- Father
Parent's Name*
Title First Last
Nationality
Work Place and Address*
Work place Street Address City Post Code
Work Phone
Email*
Enter Email Confirm Email
Mobile*
Parent Details
Please fill out second parent's contact details. Leave blank if single parent.
Parent's Details
- Mother
- Father
Parent's Name*
Title First Last
Nationality
Work Place and Address*
Work place Street Address City Post Code
Work Phone
Email*
Enter Email Confirm Email
Mobile*
Nanny Details
Please fill out Nanny's contact details if applicable
Name
Title First Last
Mobile
Emergency Contact
Contact in case of Emergency (other than your own)
Name*
Title First Last
Mobile*
Relationship to child*
Languages
Please state languages spoken at home
Health Issues / Allergies
Does your child have any health issues or allergies?*
- Yes
- No
Please state any Health Issues or Allergies your child may have*
Registration Fee
A non-refundable registration fee of £60 is required.*
I have completed the bank transfer
Bank transfer to: Natwest Acc. Pangbourne House Ltd. 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.
Signature & Consent
How did you find out about Pangbourne House?*
Excursion Agreement*
I agree to my child visiting St. Mark's Park, the local library, and any other educational settings.
Digital Signature*
Please enter your name
Registration Date*
Date Format: DD slash MM slash YYYY
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. Your personal information is not stored in the database of this website.
Comments
This field is for validation purposes and should be left unchanged.

Contact Us

Pangbourne House
2 Pangbourne Avenue
London W10 6BT
info@pangbournehouse.com

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Pangbourne House Online Registration Form

Child Details

Parent Details

Parent Details

Nanny Details

Emergency Contact

Languages

Health Issues / Allergies

Registration Fee

Signature & Consent

Contact Us

Our Story

Curriculum

Resources

Pangbourne House

Online Registration Form