Westonbirt Summer School Family Programme
Registration of Interest Form
Dates you would like to book for Westonbirt Family Programme
Sunday 5 July - Sunday 12 July (week 1)
Sunday 12 July - Sunday 19 July (week 2)
Sunday 19 July - Sunday 26 July (week 3)
Sunday 26 July - Sunday 2 August (week 4)
Sunday 2 August - Sunday 9 August (week 5)
Sunday 9 August - Sunday 16 August (week 6)
Parent's Personal Details
Parent's Full Name
*
First Name
Last Name
Parent's Full Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent's Mobile Number
*
-
Country Code
-
Area Code
Phone Number
Parent's Email
*
example@example.com
Additional Parent Name
First Name
Last Name
Student Details
Student Name
*
First Name
Last Name
Student Date of Birth
*
-
Month
-
Day
Year
Date
Student Nationality
*
Student Gender
*
Student's current school name (primary or secondary)
Booking Information
Correspondence Information - if different from parent email
First Name
Last Name
Correspondence email - if different from parent email
example@example.com
Please confirm who should be contacted with all Family Programme information
*
Parent only
Agent only
Both parent and agent
Other Details
Do you have any specific requests or any other information you would like us to know?
How did you hear about Westonbirt's Family Programme?
The terms & conditions can be found here:
Terms & Conditions
We agree to the Terms and Conditions of Westonbirt Summer School's Family Programme.
*
Yes
Submit
Are you an agent/have you been introduced by an agent?
*
Yes
No
If Yes - please confirm name of Agency
Should be Empty: