Sherborne International Registration Form

Registration Form 2015

Course Information Summer Courses run by Sherborne International - £1235 per week The price includes tuition of 30 lessons a week; testing; learning materials; educational resources; class trips and activities; all meals, snacks, and refreshments; accommodation in our school boarding houses; end of course written report and interim reports for students staying for six or more weeks; certificate of attendance; full afternoon sports and activities programme; programme of evening activities, events and entertainment; programmed excursions; laundry twice a week.

The courses run from 1 July – 26 August. Courses start and end on Wednesdays 1, 15, 29 July and 12 August, finishing on Wednesday 26 August. Students come for 2, 4, 6 or 8 weeks.

Course Dates Required - please tick relevant box for dates required Arrival:

Wednesday

Departure: Wednesday Number of weeks:

2

1st July

15th July

29th July

12th August

15th July

29th July

12th August

26th August

4

6

8

Optional Extras - please tick relevant box for dates required Two 60-minute one-to-one lessons (indicate if more required) £160 (one-to-one lessons are subject to availability but we will do our best to accommodate your request)

Transfer from and to the airport – London Heathrow, London Gatwick is charged at £95 per person each way. Please ask for a quote for other airports.

Once travel details are known, please complete and return the travel form you will be sent with the confirmation documents at least 30 days before the intended arrival date.

An additional optional trip to London by train is offered most Sundays, charged at £80 (14-17 year olds only) (London Eye for view over London, see Big Ben and the Houses of Parliament, Oxford Street Shopping). This can be booked now and can also be booked on site and paid for from pocket money. This is additional and separately organised from the regular excursion programme. More information about this trip can be provided by the office. Places may be limited, but we will do our best to include everyone who books in advance for one of the Sundays they are present.

If you tick this option, you must also tick the permission below. Even if you do not tick this option now, you may tick the permission below if you are happy for your child to join the trip (14-17 year olds only) in case they decide they want to go during the courses.

I give permission for my child (14-17 yr olds only) to join the London trip on one of the Sundays on which it is offered, date to be confirmed after arrival. Students on the London trip have some time in friendship groups unaccompanied by staff to go shopping for about 2 hrs 30 mins. The students will go on the London Eye and travel on the train from Sherborne and on the Underground in London in a group with staff (all included in the price).

SECTION A

Student Information First Name(s) ___________________________________________

Family Name ____________________________________

Nationality _________________________________________________ Gender (please tick)

Male

Date of Birth Day

Day

Country of Birth ______________________________

Female Month

Year

Mobile number on which the student can be contacted during the course (if available) _______________________________

Passport Information Passport Number ___________________________________________ Expiry Date ____________________________________ Country of Issue ____________________________________________________________________________________________

Language Information First Language (mother tongue) _______________________________________________________________________________ Language spoken at home (if different) ________________________________________________________________________ Any other languages spoken _________________________________________________________________________________ Level of English (please tick one only):

Beginner

Elementary

Intermediate

Advanced

Parent / Legal Guardian Details Title (please tick)

Dr

Mr

Mrs

Ms

Other ________________

First Name(s) ___________________________________________

Family Name _____________________________________

Telephone (home) ________________________________________ (including country code)

Mobile ________________________________________

24-hour contact number in case of emergency __________________________________________________________________ Email _____________________________________________________________________________________________________ Home address _____________________________________________________________________________________________ ___________________________________________________________________________________________________________ City ____________________________ Country ____________________________ Post Code ____________________________ Agent telephone ___________________________________ Agent email _________________________________________ (including country code)

General Information Has your child attended a Sherborne International summer course previously?

Yes

No

Has a brother/sister attended a Sherborne International summer course previously?

Yes

No

How did you hear about Sherborne International Summer?

Agent/Consultant

Friend

Family

Internet

Brochure

Other (please specify) _______________________________________________________________________________________

Accommodation Students are housed in single or shared accommodation.

Please state your preference:

Single

Twin

When shared, a student will be paired with a child of a different first language. If, however, your child would prefer to share with a friend, please state their name __________________________________________________________________________________________________________ We will do our best to meet your preferences, subject to availability and suitability.

7-12 year olds and 13-17 year olds are in separate boarding houses.

Going into Sherborne Students in the junior boarding house can go into town only if accompanied by an adult. However, if your child is 11 or 12 years old, you may wish to give her/him your permission to be allowed into town with friends (never alone) at set times, signing out and back in. Also, when the students are on excursions, senior students are allowed to go off with their friends (for example, in a shopping area) during designated periods without adult supervision. They report back at set times and the area in which they are located is patrolled by members of staff. All students of any age will be accompanied by adults at all other times (for example during evening activities). Children aged 7-10 will be accompanied at all times by an adult.

If your child is 11 or 12 years old, please tick the following: I give permission for my 11-12 year old child to go with friends into Sherborne without an adult Yes

No

I give permission for my 11-12 year old child to go with friends on excursions without an adult Yes

No

If your child is younger than 11 and you want to give this kind of permission, please email the Director of Short Courses (dbarker@sherborne-international.org).

SECTION B

Student Medical Information Has your child suffered in the past from any major illness or injury?

Yes

No

If yes, please give details _______________________________________________________________________________ ______________________________________________________________________________________________________ ______________________________________________________________________________________________________ ______________________________________________________________________________________________________ Does your child suffer from any current medical conditions we should know about?

If yes, please give details

Yes

No

______________________________________________________________________________________________________ ______________________________________________________________________________________________________ ______________________________________________________________________________________________________ ______________________________________________________________________________________________________ ______________________________________________________________________________________________________

Will your child bring any medication to school?

Yes No If yes, please indicate the reason, name of medication, dosage and times to be administered and for how long ______________________________________________________________________________________________________ ______________________________________________________________________________________________________ ______________________________________________________________________________________________________ ______________________________________________________________________________________________________ ______________________________________________________________________________________________________ ______________________________________________________________________________________________________

Does your child have any significant allergies or special dietary requirements?

If yes, please give details

Yes

No

______________________________________________________________________________________________________ ______________________________________________________________________________________________________ ______________________________________________________________________________________________________ ______________________________________________________________________________________________________ ______________________________________________________________________________________________________

Will your child be able to participate fully in all aspects of the programme, including all sports, activities and excursions?

No Yes If no, please give details __________________________________________________________________________________________________________ __________________________________________________________________________________________________________ __________________________________________________________________________________________________________ __________________________________________________________________________________________________________ __________________________________________________________________________________________________________ __________________________________________________________________________________________________________

Medication Please note that all medicines brought on campus must be handed in to matron upon arrival. There are strict regulations in regard to the management of medicines. We can accept responsibility only for drugs licensed in the UK. Please send medicines that are prescribed by a doctor along with an English translation.

A nurse, matron or agreed member of staff can administer non-prescription medications, such as paracetamol, Ibuprofen, cough linctus, throat lozenges, anti-histamine and travel sickness pills.

Please tick if you DO NOT authorise this and explain your reason _____________________________________________ __________________________________________________________________________________________________________ __________________________________________________________________________________________________________ __________________________________________________________________________________________________________

Emergency Treatment Do you authorise Sherborne International to administer emergency first aid and to act on your behalf in a medical emergency?

Yes No If no, please state reasons and indicate what action we should take in case of a medical emergency __________________________________________________________________________________________________________ __________________________________________________________________________________________________________ Emergency Contact person _____________________________ Emergency Number ________________________________ We will make every reasonable effort to contact a parent or legal guardian before permitting treatment as advised by the medical authorities present.

PARENT/GUARDIAN WITH PARENTAL AUTHORITY. Please sign to confirm this information is correct.

Signature ___________________________________________________________________ Date _______________________

SECTION C

Methods of Payment There is a deposit of £350 to secure a place. This deposit is not refundable in any circumstances. The balance is due 30 days before the student is due to start the course. If the balance is not paid by this date, the reservation may be cancelled and the place given to a student on the waiting list. Any booking made less than 30 days prior to the start of the course must be accompanied by full payment. You will receive an invoice for the balance due with your confirmation documents.

I wish to pay the deposit of £350 by (please tick one only) Sterling Cheque or Bank Draft, payable to Sherborne School Bank Transfer

Credit Card (Visa/ MasterCard /American Express)

Details for payment by bank transfer – Lloyds TSB Bank, Sherborne Account No 01884627 Sort Code 30 99 98 IBAN No: GB12 LOYD 3099 9801 8846 27 SWIFT No: LOYDGB2L BIC No: LOYDGB 21208 I understand that I am responsible for any charges incurred when payment is made by bank transfer and will instruct my bank to deduct any charges made by my and your bank from my account Please complete and fax or scan to us with a copy of your bank transfer MasterCard/ Visa/ American Express Card Expiry Date

Month

Year

Security Code

AMEX

Please note that there is a surcharge of 2.1% on any transaction by credit card over £350. There is no surcharge on debit card payments.

The balance of fees can be collected by credit card 30 days before start of course, but there is a 2.1% surcharge on any transaction over £350. Do you wish the balance of fees to be collected from your credit card as detailed above?

Yes

No

Name on card ________________________________________________________________________________________

Cardholder signature _________________________________________________________________________________

Dear Student – we are looking forward to welcome you this summer onto our courses. Please sign below to say you have read the code of conduct and agree to follow it.

Signature ______________________________________________________________ Date ________________________

Dear Parent or Legal Guardian – please sign below to confirm: • The information I have given in this form is correct, including all information in Section B: Student Medical Information • I have read and accept the Terms and Conditions attached and the School Regulations and I agree that my child will follow the course rules and English law • I give permission for my child to attend all activities and sports organised by Sherborne International (including mixed sports and with staff playing alongside students) • I give permission for my child to participate in any age appropriate, risk assessed and supervised additional trips that may be organised for groups of students as part of the courses • I give Sherborne International permission to act on my behalf when dealing with a medical emergency in line with professional medical advice – Sherborne International will make every effort to contact me in such an emergency

Signature ______________________________________________________________ Date ________________________

Is it OK for us to include your child in photos on our website galleries that you will be able to look at during the course?

Yes

No

Is it OK for us to include photos of your child in our newsletter sent to parents, brochures or other promotional materials?

Yes

No

Is it OK to use quotes of your child’s work or writing on our website or in our newsletter, brochure or other promotional materials?

Yes

No

Our acceptance is on the understanding that your child is in good physical and mental health and that he/she will behave responsibly showing respect to students and staff. We look forward to welcoming him/her on our courses this summer and hope she/he will have an enjoyable and successful time.

Agent’s Stamp

SECTION D

Confirmation of Booking

www.sherborne-international.org

SHERBORNE INTERNATIONAL, NEWELL GRANGE, SHERBORNE, DORSET DT9 4EZ, UK Tel: (UK) 01935 814743 • (International) 44-1935 814743 Fax: (UK) 01935 816863 • (International) 44-1935 816863 E-mail: reception@sherborne-international.org • Website: http://www.sherborne-international.org Sherborne School is a registered Charity No. 1081228.