Registration Form

Waiting List Only

Please note that inclusion on the waiting list does not guarantee your child a place at any of the departments listed below.

Once submitted the school office will contact you directly to confirm receipt and arrange settlement of the registration fee.

Name of child *

Sex *
MaleFemale

Date of Birth *

No. of siblings *

Names and DOBs

Details of any known learning difficulties or medical conditions

Does your child speak any other language at home other than English? *
YesNo
if yes, what language?

Mother’s Name *

Mother's Email *

Mother's Mobile Telephone Number

Occupation *

Father’s Name *

Father's Email *

Father's Mobile Telephone Number

Occupation *

Main Home Address (for correspondence) *

Home Telephone Number *

Proposed Primary School

How did you hear about Bertrum House Nursery?

If other, please specify:

Would you be happy to receive information about the Nursery via email?