UK High School Immersion Enrolment Form 2021

Student Enrolment Form

Fill out the form carefully for registration
Student Name

First NameMiddle NameLast Name
Birth Date

DayMonthYear
Gender
Nationality
e.g. Spanish, German, Chinese
Primary Language
e.g. French, Catalan, Mandarin
Profile Photo of Student

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ID or Passport Number
ID or Passport Number
Photocopy of Official ID

Upload a File
Please provide a good quality photocopy Cancelof
Parent or Guardian's Name

PrefixFirst NameLast Name
Parent's Contact Mobile Number

Country CodeArea CodePhone Number
Student's Mobile Number

Country CodeArea CodePhone Number
Family Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Next of Kin

PrefixFirst NameLast Name
Relation to Student
e.g. Mother, Father
Emergency Contact Mobile Number

Country CodeArea CodePhone Number
Emergency E-mail
Personal Requirements
Allergies (Animals, Food and medical etc)
e.g. Allergic to dogs, allergic to dust mites, allergic to pencillin
Dietary requirements
e.g. Vegetarian
Medication
Please ensure you have arrangements made for all medications
Special Requirements
e.g. Dyslexia, ADHD etc
Study Placement & Logistics
Number of years studying English
Estimated proficiency
Placement dates
Preferred School
Flight Arrival

DayMonthYearHourMinutesAM/PM Option
Arrival Airport
Arrival Flight Number
Carrier
Departure Flight Time

DayMonthYearHourMinutesAM/PM Option
Departure Airport
Departure Flight Number
Carrier
Do you require an unaccompanied minor service?
Signature
Print Name

First NameLast Name
Should be Empty:

Student Enrolment Form

Personal Requirements

Study Placement & Logistics