Application Form

Application Form
Child's Details
Name

First NameMiddle NameLast Name
Gender
Date of Birth

DayMonthYear
Date
Age when course begins
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Nationality
Summer School Course Choice
Reference Number (Please see email)
Does your child have any medical or dietary requirements we need to be made aware of?
Parent/Carer Details
Name

First NameLast Name
Relationship to Child
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Contact Number
Email
example@example.com
Alternative Contact

Please provide details of an alternative contact if we are unable to contact you.
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Contact Number
Email
example@example.com
Relationship to Child
Please check the box below if you would like to add another alternative contact

Yes
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Contact Number
Email
example@example.com
Relationship to Child
Please let us know if there is anyone who is NOT allowed to have contact with, or to collect, your child/ward
Consents Required
I/We consent to my child/ward being taken off site during Summer School for activities which may involve travelling by minibus.

YesNo
I/We consent to the possibility of Summer School taking photographs or filming my child/ward which may be used for publicity in the future. Please note that any photographs and/or videos that appear in Summer School publications (e.g. brochure, advertising) will have been taken by authorised Summer School photographers videographers only.

YesNo
I/We consent to Pastoral staff applying sun cream to my child/ward if required.

YesNo
I/We approve medical treatment for our child/ward is deemed necessary in an emergency on the advice of a qualified medical practitioner or registered nurse (as per Shrewsbury Summer School Terms & Conditions).

YesNo
Shrewsbury Summer School will only use your personal information to administer your account and to provide the products and services you requested from us. From time to time, we would to contact you about our products and services, as well as other content that may be of interest to you.

YesNo
Declaration

I hereby that the information I have provided is correct. I understand and agree that the failure to disclose any medical, psychological or dietary issue that could affect my child's/ward's ability to participate fully, or may be to the detriment of another student's enjoyment of Summer School, may result in them being removed from the course and that, in this instance, Shrewsbury Summer School will not be obliged to reimburse any fees, in part or in full.
Name

First NameLast Name
Date

DayMonthYear
Date
Relationship to Child
Should be Empty:

Application Form

Child's Details

Parent/Carer Details

Alternative Contact

Consents Required

Declaration