Enrolment Form
Please complete this form in ENGLISH

Full name

English name

Date of birth

Gender

Name of School:

Form/class at the start of the academic year

Please upload a passport-sized photo/selfie:

Home address line 1

Home address line 2

Home address line 3

Student's mobile number:

(+852) ########

(parents/guardians, there is a section for your telephone number later in the form)

Student's email address

(parents/guardians, there is a section for your email address later in the form)

Please tick 3 traits to best describe your personality

Please tick 3 traits to best describe your interests

RESIDENTIAL PREFERENCES AND HEALTH INFORMATION

Please note, Excel cannot guarantee that room‐type preferences (e.g., single or twin bedroom) will be met in all cases.

Friend's name you would like to be your buddy (only one, if applicable):

Make sure your friend agrees and writes YOUR name on their form!

Please specify any special dietary requirements (leave blank if none):

e.g. vegetarian

Please specify any food allergies (leave blank if none):

e.g. nuts, fava beans

If you have any food allergies, please specify severity if consumed:

e.g. very severe (hospitalisation), severe (medication), mild (no action required)

Please list any food allergy medication, including dosage (leave blank if none):

If you require medication for food allergies please confirm you will bring it with you, are aware of the dosage and how to take it:

Please indicate any allergies (leave blank if none):

e.g. to medicines, antibiotics

Please state any current medical conditions (leave blank if none):

e.g. asthma, epilepsy, attention deficit disorder (ADD)

Please indicate any other medication you will be bringing with you (leave blank if none):

Please confirm that you are aware of the dosage and how to take it:

Please rate your standard of English on a scale of 1-5, where 1 is the lowest and 5 is the highest:

Reading

Speaking

Writing

Grammar

Listening

Vocabulary

Which two aspects do you wish to improve the most?

Father's name:

Father's mobile number:

(+852) ########

Father's email address:

Mother's name:

Mother's mobile number:

(+852) ########

Mother's email address:

Please provide up-to-date, valid email addresses for correspondence relating to your child's application. Your information will not be shared with any third party

ADDITIONAL INFORMATION (Please include any additional information which you feel may be relevant to your application e.g. reasons for applying for this trip, special departure information, other emergency contact details)

I give permission to the Excel Academy representative to take any appropriate measures in an emergency, which are deemed necessary to safeguard the well-being of my child

I accept responsibility to undertake all necessary arrangements (including payments) to repatriate my child in case of emergency resulting from illness, serious accident or unacceptable behaviour, as deemed by the Excel Academy

I accept responsibility to pay for any damages (accidental or otherwise) caused by my child upon receipt of a valid report & receipt/ invoice

I will make sure that my child follows the instructions of their accompanying group leader(s) and Excel Academy staff while they are staying in the UK

I understand that during the programme, my child is NOT allowed to go on any unauthorised or unsupervised outings

I accept the Excel Academy's curriculum enrichment programme terms & conditions listed above and included in the brochure (online version at: https://www.excelacademy.london/brochure)

I confirm that my child is up-to-date with their immunisation and is healthy (both physically and mentally) to participate on the programme

I give consent to the Excel Academy to take photographs of my child for internal purposes, including the programme's blog

Date

Parent/Guardian's full name

Parent/Guardian's signature

Please upload a scanned or digital signature

Please inform us if you do not wish photographs of your child to be used for external purposes, e.g. brochures

Please tick here if you wish to be included on the Excel Academy’s alumni mailing list:

Enrolment FormPlease complete this form in ENGLISH

Enrolment Form
Please complete this form in ENGLISH