Little Pangbourne

Online Booking Form

Wednesday Stay & Play – 9.00am to 10.45am

£150 for the term

Includes a 20 minute sing-a-long

Age: 6 months to 2 years

Child Details
Child's Name*
First Last
Date of Birth*
Date Format: DD slash MM slash YYYY
Address*
Street Address City Post Code
Home Tel
Parent Details
Select Parent*
- Mother
- Father
Parent's Name*
Title First Last
Nationality
Work Address*
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*
Three Terms per Year
Please select which term you are interested in*
- AUTUMN TERM (mid-September to end of November)
- SPRING TERM (mid-January to end of March)
- SUMMER TERM (April/May to end of June)
Important Information
Children must be accompanied by an adult

Please bring in a piece of fruit. No Nuts Please.

Please bring in nappies, wipes and anything your child may need.
Signature & Consent
How did you find out about Pangbourne House?*
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.
Phone
This field is for validation purposes and should be left unchanged.

Child Details
Child's Name*
First Last
Date of Birth*
Date Format: DD slash MM slash YYYY
Address*
Street Address City Post Code
Home Tel
Parent Details
Select Parent*
- Mother
- Father
Parent's Name*
Title First Last
Nationality
Work Address*
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*
Three Terms per Year
Please select which term you are interested in*
- AUTUMN TERM (mid-September to end of November)
- SPRING TERM (mid-January to end of March)
- SUMMER TERM (April/May to end of June)
Important Information
Children must be accompanied by an adult

Please bring in a piece of fruit. No Nuts Please.

Please bring in nappies, wipes and anything your child may need.
Signature & Consent
How did you find out about Pangbourne House?*
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.
Name
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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