Student information form
Student’s Full Name *
Date of birth*
Gender* M F
Nationality*
Home address*
Religion*
First language*
Other languages spoken*
Student’s mobile*
Name and address of the school and boarding house *
School Year
Parents Contact Details
Parent 1
Full name *
Address*
Phone number*
Email*
Occupation*
Parent 2 (secondary contact person)
Full name
Address (if different)
Phone number
Email
Occupation
UK family member contact details
Full name
Address
Phone number
Email
Occupation
Student family background (please provide details)
Medical / personal information
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.
Permissions
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? * Yes No
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)* Yes No
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? * Yes No
Do you consent to your child travelling by any form of public transport? * Yes No
Do you consent to your child taking part, under adult supervision, in water sports, rides and other entertainment activities suitable for their age? * Yes No
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 * Yes No
* By submitting this registration form, I hereby accept full liability in respect to the guardianship contract. I agree to make payments in accordance with the terms stated in the contract and no later than in 14 days after the issue date of the invoice. I understand that in case I wish to terminate the contract, I shall give a written notice no later than one term prior to the termination date. I confirm that information provided is up-to-date and accurate. In case my contact details change, I will immediately inform English Guardian.
Thank you