Please complete all relevant fields. Should you have any questions on completing this form, please call us on +44 203 3977744 or email us at firstname.lastname@example.org.
Student’s Full Name *
Date of birth*
Other languages spoken*
Name and address of the school and boarding house *
Full name *
Address (if different)
Does the student have any allergies? If yes, please provide details.
Does the student have special dietary requirements? If yes, please provide details.
Does the student suffer from any serious medical condition or disability? If yes, please provide details.
Is the student currently taking any medications? If yes, please provide details.
Have the student ever suffered from any infectious diseases? If yes, please provide details and dates.
Does the student suffer from travel sickness?
Is there any reason why the student cannot take part in active games or sports?
Does the student have private medical cover? If yes, please provide details and dates of the policy.
Does the student have any learning difficulties? If yes, please provide details.
Student's interests, hobbies, likes, dislikes, and his or her personality in general.
If you cannot be contacted, do you consent to all emergency medical or dental treatment including inoculations, general or local anaesthetic, surgery or blood transfusions which, in the opinion of a qualified doctor, are necessary for your child's safety and well being, under the National Health Service or privately if necessary? *YesNo
Do you consent to the administration of medication such as paracetamol, cough mixture, eye drops etc normally sold over the counter by a chemist for treatment of minor ailments (always taking into account medical information you have supplied to the guardian)*YesNo
Do you consent to your child travelling in a car driven by a responsible adult who is duly licensed and insured to drive a vehicle of that type? *YesNo
Do you consent to your child travelling by any form of public transport? *YesNo
Do you consent to your child taking part, under adult supervision, in water sports, rides and other entertainment activities suitable for their age? *YesNo
Do you consent photographs and / or videos of your child being taken and grant full rights to use the images and any reproductions or adaptations of the images for publicity. This might include (but is not limited to), the right to use them in their printed and online publicity, social media and press releases *YesNo