Your Forename *

Your Surname *

Relation to Child *

Your Email *

Primary Phone Number *

Secondary Phone Number

Street Address *

City*

Postcode *

Child’s Forename if known (if unknown, please enter 'Baby') *

Child's Surname *

Child's Date of Birth / Due Date *

For entry into our half day programme, please indicate if you are interested in:
Morning SchoolAfternoon SchoolNo Preference

Do you have a prior connection to Broadhurst School *

How did you hear of us? *

Message:

We take your privacy seriously and will only use your personal information to administer your account and to provide the information you have requested from us.

However, from time to time we would like to contact you with details of our open days, events and news that we provide. if you consent to us contacting you for this purpose please tick to say how you would like us to contact you: