Anglo Academy UK Easter Camp 2020
Please complete this form as accurately as possible. Please note that all information given to us is strictly confidential and will not be passed onto any third parties.

This form is to be completed for EACH individual child, including children within the same family.

Please note that we cannot accept any students onto the course without this form of consent.
Student Information
First name of student (as shown in official identification) *
Your answer
Surname of student *
Your answer
Other/ Preferred name
Your answer
Sex *
Date of birth *
MM
/
DD
/
YYYY
Nationality *
Your answer
Name of UK school *
Your answer
Name of UK Guardian *
Year group *
Which subjects does your child study? *
Required
Which subjects do you want your child to be tutored in? (extra tutoring)
Is your child taking A-level or GCSE this year? *
Which exam board is your child taking? *
Required
Start date of the camp *
MM
/
DD
/
YYYY
End date of the camp *
MM
/
DD
/
YYYY
Which course will your child be joining? *
Parental Information
Forename of Mother *
Your answer
Surname of Mother *
Your answer
Forename of Father *
Your answer
Surname of Father *
Your answer
Parent's Phone Number (including country code) *
Your answer
Emergency Contact Full Name *
Your answer
Emergency Phone Number (including country code) *
Your answer
Relationship to Student *
Your answer
Email address *
Your answer
Home address *
Your answer
Level of English for correspondence and emergencies *
Preferred form of communication *
Medical Emergencies: Can you confirm that you consent to all emergency medical or dental treatment, in the opinion of a qualified doctor, are necessary for your child's safety and well being, under the National Health Service or privately if necessary? *
Can you confirm that you consent to the photos of your child to be taken and used in Anglo Academy's publication and social media sites? *
Please list any specific activities in which you do not consent to your child taking part
Your answer
Please list any medical, allergy or dietary information that applies to your child
Your answer
UK contact (if any) - name, email and telephone number
Your answer
Are you a Belgravia student? *
How did you hear about Anglo Academy? *
Consultant/ Referral (if any)
Your answer
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