Rossall Summer School 2024 (NEW)

STUDENT INFORMATION
Student's Full Name:*

First NameLast Name
Birth Date:*

MonthDayYear
Sex:*

BoyGirl
Nationality:*
Place of Birth:*
First Language:*
Special Needs or Disabilities (please give details):
Passport Number:*
Place of Issue:*
Number of years studying English:*
Current Level of English:*

BeginnerIntermediateAdvanced
Please upload a copy of your passport.*

pdf, doc, html, zip, mp3, avi, jpg, png etc.
Cancelof
Please upload a recent copy of the pupil's school report.*

pdf, doc, html, zip, mp3, avi, jpg, png etc.
Cancelof

PARENT INFORMATION
Biological Parent/Legal Guardian 1 details:*

PrefixFirst NameLast Name
Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number:*
Mobile Number:*
Fax Number:
E-mail:*
example@example.com
Occupation:
Please upload a copy of your passport.*

pdf, doc, html, zip, mp3, avi, jpg, png etc.
Cancelof

Biological Parent/Legal Guardian 2

If the student is no longer in contact with biological parent 2, please provide an additional contact.
Biological Parent/Legal Guardian 2 details:*

PrefixFirst NameLast Name
Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number:*
Mobile Number:*
Fax Number:
E-mail:*
example@example.com
Occupation:
Please upload a copy of your passport.*

pdf, doc, html, zip, mp3, avi, jpg, png etc.
Cancelof

Rossall Student Declaration, Rules and Drugs Policy

Rossall Rules

All Rossall Sumer School pupils must:
1. Fulfil all Rossall Summer School commitments: lessons, games, meals, extra-curricular activities etc.
2. Treat each other, all members of the Rossall Community, and all members of the public with respect, courtesy and consideration.
3. Takes care of all personal property, that of others, as well as their own, and of the fabric of Rossall.
4. Show respect for, and give all possible assistance to visitors, as has always been the tradition for Rossall.
5. Be conscious at all times that the good name of Rossall is in their hands, and that their conduct must be a credit to Rossall.
Whilst a member of Rossall, any student may not:
- Smoke nor have possession of any smoking materials
- Consume nor have possession of any illegal substance
- Consume nor have the possession of any alcohol, without due authority
- Use nor have possession of a firearm or other weapons, ammunition or any explosive substances, including fireworks
- Engage in gambling
- Use nor have possession of the property of another student without the willing permission of the owner
- Buy or sell property, nor borrow money, without the permission of the Houseparent(s)
- Indulge in personal relationships of a physical nature with another pupil
Signature of the student

Clear
Date
Student's Name*

First NameLast Name
Birth Date:*

MonthDayYear

Rossall Drugs Policy

Statement of Policy

It is Rossall policy that it shall actively discourage the use of controlled drugs and shall treat all cases of use by its students or staff as serious misconduct.

Implementation of this policy

Where a member of staff suspects that a student is using a controlled drug, or there is evidence of equipment used in connection with the use of such substances or there is information which indicates such use, the matter will be investigated by the Summer School Director.

After considering the evidence, the Summer School Director, or a delegated representative may require the student to take a urine test. This test shall be carried out in accordance with a strict procedure and takes place in the school medical centre under circumstances of the strictest hygiene and care, whilst still maintaining the privacy and dignity of the student. The sample shall be submitted to an independent laboratory for testing. A second sample will be available, on request, for re-testing by another laboratory, if required, by the parents.

Discipline following misuse

If the test is positive, the Summer School Director will exercise their discretion as to whether the student will be allowed back to school after a period of suspension. If the student is re-admitted, it will be on the express understanding that random testing will occur. Any second offence will lead to immediate and permanent exclusion.

Any student caught in the possession of or using controlled drugs or being in possession of them with intent to supply shall invariably be expelled.

The above is a summary of the Rossall Drugs Policy Document: a full copy of this document is available on request. As a Condition of Acceptance, parents are required to sign the following form and return this slip when applying to Rossall Summer School.
Student's Name*

First NameLast Name
Parent 1 Name*

First NameLast Name
Signature of parent 1

Clear
Date
When the pupil is over 16 at the beginning of term, or will become 16 during the term, the pupil's consent is also required to the following statement.

Student Declaration
Signature of the student*

Clear
Date

Medical Records

All welfare notes will be held at the school medical centre. It is important that the School Medical Officer is aware of the medical history of your child including details of previous illnesses, vaccinations and immunisations that have been given. Please complete this form and return when applying to Rossall Summer School.

As a school, we are continuing to monitor the Ebola Virus outbreak in West Africa.We take the health and well-being of our students, staff and families very seriously and would ask that the School is informed if any student, or close family member of a student, being enrolled in the Summer School has had contact, visited or resided in any of the infected countries.

Our school doctor, professional educational bodies and Public Health England have provided the school with comprehensive guidance and we are assured that the risk of the virus coming to the UK and to our students remains very low.
Doctor's Title and Full Name:*

PrefixFirst NameLast Name
Doctor's Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Doctor's Phone Number:*

Please indicate whether your child has had any of the following illnesses together with the age at which it was contracted.

	YES/NO	AGE
Chicken Pox
Whooping Cough
Measles
Hepatitis
Glandular Fever
Diabetes
Asthma
Mumps
German Measles
Infantile Paralysis (Polio)
Tuberculosis
Epilepsy

Please indicate if your child has been vaccinated or immunised against the following:

	YES/NO	AGE	DATE (dd/mm/yy)
BCG (for TB)
Measles/Mumps/Rubella
Hepatitis A
Meningitis C
HIB
Pneumococcus

D.P.T

	2 months DATE (dd/mm/yy)	3 months DATE (dd/mm/yy)	4 months DATE (dd/mm/yy)	Pre-school DATE (dd/mm/yy)
Diphtheria
Tetanus
Polio

Please indicate any allergies your child might have, for example Asthma, Nut Allergy, Latex, Hay Fever, Drugs Allergies:
Please give details of any serious illnesses, accidents or operations that your child has had in the past, stating the date:
Does your child require an asthma inhaler?*

YesNo

If yes, please provide details:

	Please state
Name:
Dosage:
Times of Administration:

Has your child received a vaccination in the last 12 months?*

YesNo
If yes, please provide details.
Boarders who wear glasses should bring a copy of their prescription to school and deposit it at the Medical Centre. They must bring a spare pair of glasses with them for use in case of loss or damage. Pupils who wear contact lenses must bring a spare pair of glasses for use in case a lens is lost or there is an eye injury or irritation. Protective eyewear should be used for squash or fives.

When your son/daughter returns home for a holiday, they will bring with them a health form which you are required to complete and return to the School.
Please detail below any special needs that your child might have, e.g. learning difficulties, disability, social difficulties etc.
Signature of parent 1*

Clear
Date
Signature of parent 1*

Clear
Date

Image Release

By agreeing to the School's terms and conditions, you consent to photographs and digital images of your child being used in the publications produced by Rossall School.

You agree that they will be used for educational purposes only and that no information will be revealed concerning the child's identity (other than reference to their full name, age, residential district and/or year group where relevant).

You agree that the images may also be used in, and distributed by, media other than printed publications such as, but not limited to, DVD, the World Wide Web, press releases and advertising pertaining to Rossall's activities.

PHOTO AND VIDEO RELEASE - Please indicate below how we can use your child's image*

	Yes	No
My child can be used in printed material
My child can be used on the website
My child can be used on social media
You can name my child (First name only)

Child's Name*

First NameLast Name
Parent's Name*

First NameLast Name
Signature of parent 1*

Clear
Date

Declaration

An registration fee of £125 will be required to secure a place on the Summer School. This is in addition to the fees and is non-refundable. The fees for the course are due one month before the start of the course and will be invoiced. Please note, you will be sent through to World Pay to complete the booking when you submit this form.

My Products

Summer School Registration Fee

£125.00

Total

£0.00

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Parent's Name:*

First NameLast Name
Signature of parent 1*

Clear
Date:*

MonthDayYear
Please note the offer of a place is subject to availability, the entry requirements at the time and the standard Terms and Conditions of Rossall School. Cancellation of a Summer School place requires a notice period of ONE MONTH. Refunds cannot be issued for places cancelled less than a month before the first day of residency.
Finally, how did you hear about the course?*

Rossall School websitePress advertisingAgentExhibitionAnother websiteSchool recommendationFriend/family recommendation
Please state the name of your agent
Should be Empty:

STUDENT INFORMATION

PARENT INFORMATION

Biological Parent/Legal Guardian 2

Rossall Student Declaration, Rules and Drugs Policy

Rossall Rules

All Rossall Sumer School pupils must:

Whilst a member of Rossall, any student may not:

Rossall Drugs Policy

Statement of Policy

Implementation of this policy

Discipline following misuse

Student Declaration

Image Release

Declaration