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) *
Surname of student *
Other/ Preferred name
Sex *
Date of birth *
Nationality *
Name of UK school *
Name of UK Guardian *
Year group *
Which subjects does your child study? *
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? *
Start date of the camp *
End date of the camp *
Which course will your child be joining? *
Parental Information
Forename of Mother *
Surname of Mother *
Forename of Father *
Surname of Father *
Parent's Phone Number (including country code) *
Emergency Contact Full Name *
Emergency Phone Number (including country code) *
Relationship to Student *
Email address *
Home address *
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
Please list any medical, allergy or dietary information that applies to your child
UK contact (if any) - name, email and telephone number
Are you a Belgravia student? *
How did you hear about Anglo Academy? *
Consultant/ Referral (if any)
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