Student's Details

Family name (*):

First name(s) (*):

Chosen English name (if applicable):

Date of birth (*):

Gender (*):

Nationality (*):

Religion:

Passport number:

Expiry date of passport:

Student's mobile phone number:

Student's email:

First language (*):

Other languages spoken:

Parent's Details

Father's full name (*):

Father's email (*):

Father's mobile phone number (*):

Father's first language:

Father speaks English?:
YesNo
Father's Nationality (*):

Father's Occupation:

Mother's full name (*):

Mother's email (*):

Mother's mobile phone number (*):

Mother's first language (*):

Mother speaks English?:
YesNo
Mother's Nationality (*):

Mother's Occupation:

Home address (*):

Country (*):

Home telephone number (*):

Education Details

School (*):

Year Group (*):

Start date (*):

Boarding house:

Education agent and company:

Additional information about your child

Please give details of any medical conditions:

Please provide details of any regular medication used by your child:

Allergies (including all allergies to medicines):

If your child has medical insurance, please give details of your insurance company and policy number:

Special dietary requirements:

Hobbies, sports and interests:

Host family preferences:

Declaration

(*) We consent to any urgent medical/dental treatment deemed necessary by medical/dental professionals and we authorize Trusted Guardianship to sign consent forms on our behalf. We accept that, whilst every effort will be made to contact us in the event of accident or serious illness, this may not always be possible immediately. Parents are responsible for ensuring that they provide Trusted Guardianship with up-to-date contact information for both parents. We understand that Trusted Guardianship will arrange accommodation for our child with a suitable host family and we give permission for our child to travel in the host family’s car.

Please upload a photograph of your child:

Additional Comments: