Your Details

Please answer the question below

Your name (first, last)

The format is incorrect

Please answer the question below

Contact email

Please answer the question below

Your job title

Please answer the question below

Name of school/organisation

Please answer the question below

School's post code

Your Visit

Please answer the question below

Which session would you like to book?

Please answer the question below

Please specify

Please answer the question below

Please enter a valid date and time

Preferred date & time of visit

Please answer the question below

Please enter a valid date and time

Alternative date & time of visit (in case your first is taken)

Please answer the question below

Would you like to book the Rickyard (lunch space) for your visit.

Yes

No

Please answer the question below

What are your desired learning outcomes for this session?

Your Group

Please answer the question below

Year group(s) of students attending

Please answer the question below

How many students will be attending?

Please answer the question below

How many staff/adults will be attending?

Please answer the question below

Approximately how many students in your group have Special Educational Needs and/or Disabilities (SEND)?

Please answer the question below

Approximately how many students in your group are in receipt of Free School Meals?

Please answer the question below

Please list any access needs, medical conditions, or other important considerations for your group

Other Details

Please answer the question below

Finance contact's name (for invoice)

The format is incorrect

Please answer the question below

Finance contact's email address (for invoice)

Please answer the question below

Name of the main contact on the day of your visit

The format is incorrect

Please answer the question below

Emergency contact phone number of the main contact on the day of your visit

The format is incorrect

Please answer the question below

Email address of the main contact on the day of your visit

Review

Please answer the question below

How did you hear about Pitzhanger Manor & Gallery's Schools Programme?

Please answer the question below

Please specify

Please answer the question below

Would you like to subscribe to our School Newsletter mailing list to hear more about our learning programming? We will not share your data and you can unsubscribe at any time.

Yes

No

I already am

The format is incorrect

Please provide an email address for our schools mailing list that will accept emails from our external server.

Thank you

Thank you for requesting a school workshop/visit at Pitzhanger Manor & Gallery. Someone from our Learning team will contact you shortly to confirm your request.

School Booking Request Form

Your Details

Your Visit

Your Group

Other Details

Review

Thank you