Port Regis
Motcombe Park,
Shaftesbury, Dorset
SP7 9QA. United Kingdom.
Registered No: 440436
Charity No: 306218

Tel: (+44) 01747 857800
Fax: (+44) 01747 857810
Email: office@portregis.com

Open Morning Registration Form

* Essential information required


PARENT SURNAME*
PARENT FORENAME(S)*
FULL ADDRESS* (incl postcode)
HOME TELEPHONE*
MOBILE
EMAIL*
(1) CHILD’S FULL NAME
DATE of BIRTH
YEAR / DATE of ENTRY
DAY or BOARDING
CURRENT SCHOOL

(2) CHILD’S FULL NAME
DATE of BIRTH
YEAR / DATE of ENTRY
DAY or BOARDING
CURRENT SCHOOL

PR CONNECTIONS / OPR (if applicable)
PARTICULAR INTERESTS / SPECIAL NEEDS
WHAT PROMPTED YOUR ENQUIRY TODAY?*
OPEN MORNING*