Confidential Application Form

Registered Charity No. 1027170

Tel: 01767 262807 or 07931 715015

Child's full name:...................................................... Date of Birth: ............................

Telephone No.: ................................................................... Male/Female: ...........................

Full Address: .............................................................................................................................

.....................................................................................................................................................

Email Address: ........................................................................................

please tick here if you would like to receive information by email ›

Does your child have any special needs? If so, please give details below.

I have read and agree with the information provided in the Potton Pre-School's prospectus and wish to apply for the above named child to attend...

*As soon as possible/As from............................................................ (Date)

If I find that I no longer require this place I will inform the pre-school as soon as possible.

I enclose the registration fee of £10.00 (cheques made payable to Potton Pre-School)

Name of *parent/ guardian.......................................................................................................

Signature......................................................................... Date....................................

How did you first find out about Potton Pre-School?

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